Surgical Management of Sphenoid Wing Meningioma

Background Sphenoid ridge meningiomas constitute about 11.9% of all intracranial meningiomas. In 1938, they were classified by Cushing and Eisenhardt into outer (pterional), middle (alar), and inner (deep, clinoidal) lesions. Despite technical advances in neuroimaging and microsurgical techniques, large meningiomas arising from the sphenoid wing still a surgical challenge. Patients and Methods Between May 2015 and October 2019, 40 patients with meningiomas primarily originating from sphenoid ridge were planned for surgical management either with total excision or subtotal +GKS or for GKS from the start,9 cases were lateral, 11 were meddle,14 were medial and 6 enplaque and we can summarize that in lateral and middle meningioma total excision is the main role in treatment as long as vascular structures are secured, while GKS playing essential role in medial group, small conviened lesions less than 3 cmm in maximum diameter could be treated directly with GKS, larger lesions subtotal excision as safe as possible is 1st step followed by GKS for residual, meningioma en plaque carry high incidence of recurrence as total excision is difficult and GKS could not treating hyperostotic bone. Results GKS plays a very essential role in treating medial sphenoid meningiomas (63.6%) while surgical incision is the golden standard management of other types of meningiomas (88.8%) in lateral and middle groups and (50%) in meningioma enplaque. Conclusions The surgical treatment of sphenoid wing meningiomas still represents a challenge for neurosurgeons. Surgery for sphenoid wing meningiomas poses a variety of problems reflecting the complex anatomy of the sphenoid region. The surgical decision for these tumors should depend primarily on clinical finding of the patient and radiological finding of the tumor. Location of the meningioma is an important factor determining the degree of tumor resectability. Encasement of MCA and their branches and extension into superior orbital fissure and cavernous sinus are limiting factors for radical removal.