Medial sphenoid wing meningioma [Neurosurgery Wiki]

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====== Medial sphenoid wing meningioma ======

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It is part of the heterogeous group of [[Skull base meningioma]]s

These [[sphenoid wing meningioma]]s involve the region of the anterior [[clinoid]], adjacent medial [[sphenoid wing]], [[superior orbital fissure]], and [[cavernous sinus]]. They may grow into the [[orbit]]. The tumor often encases the [[internal carotid artery]] and proximal middle and anterior cerebral artery as well as the [[optic nerve]] and may compress or provoke edema in the temporal or frontal lobes. 
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Anterior [[clinoidal meningioma]] (medial sphenoid wing) meningiomas are a subcategory of the [[medial sphenoid wing meningioma]]s.

see [[Anterior clinoid region meningioma]]
===== Epidemiology =====

Approximately ~15-20% of all meningiomas arise from the [[sphenoid wing]], with about half of these arising from the medial portion of the wing.

Meningiomas of the [[sphenoid wing]] make up approximately 15–20% of total [[cranial meningioma]]s 
((Abdel Aziz KM, Froliech SC, Cohen PL, Sanam A, Keller IT, Van Loveran HR (2002) The one piece orbitozygomatic approach: the MaCarty burr hole and the inferior orbital fissure as keys to technique and application. Acta Neurochir (Wien) 144:15–42))
((Cushing H, Eisenhardt L (1938) Meningiomas: their classifica- tion, regional behavior, life history, and surgical end results. Charles C Thomas, Springfield, pp 311–319))
((Pieper DR, Al-Mefty O, Hanada Y, Buechner D (1999) Hyperos- tosis associated with meningioma of the cranial base: secondary changes or tumour invasion. Neurosurgery 44:742–747)).

===== Classification =====

see [[Medial sphenoid wing meningioma classification]].

===== Differential diagnosis =====

[[Anterior cranial fossa meningioma]]

===== Treatment =====

see [[Medial sphenoid wing meningioma treatment]].

===== Outcome =====
[[Medial sphenoid wing meningioma]]s (mSWM) present a surgical challenge because they can grow into the [[cavernous sinus]] (CS), encircle the [[anterior circulation]] arteries, affect the [[cranial nerve]]s, and even invade the [[bone]]
((Nakamura M, Roser F, Jacobs C, Vorkapic P, Samii M. Medial sphenoid wing meningiomas: clinical outcome and recurrence rate. Neurosurgery. 2006 Apr;58(4):626-39, discussion 626-39. doi: 10.1227/01.NEU.0000197104.78684.5D. PMID: 16575326.)) 
((Tomasello F, de Divitiis O, Angileri FF, Salpietro FM, d'Avella D. Large sphenocavernous meningiomas: is there still a role for the intradural approach via the pterional-transsylvian route? Acta Neurochir (Wien). 2003 Apr;145(4):273-82; discussion 282. doi: 10.1007/s00701-003-0003-8. PMID: 12748887.)).
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The intricate location of medial sphenoid wing meningiomas (mSWM) increases the risk of surgery, leading to higher [[morbidity]] and even [[mortality]]. It is crucial to study [[preoperative]] imaging to predict which [[extent of resection]] can be achieved and decide whether to manage total resection for lower recurrence rate or partial resection for preservation of encased neurovascular structures. We have not yet had a widely accepted classification system of mSWM to predict the extent of resection in clinical practice. Recently, application of three-dimensional (3D) multimodality fusion imaging has greatly contributed to the understanding of anatomical structures and has been proved to be a promising neurosurgical tool for brain tumors
((Gandhe AJ, Hill DL, Studholme C, Hawkes DJ, Ruff CF, Cox TC, Gleeson MJ, Strong AJ. Combined and three-dimensional rendered multimodal data for planning cranial base surgery: a prospective evaluation. Neurosurgery. 1994 Sep;35(3):463-70; discussion 471. doi: 10.1227/00006123-199409000-00015. PMID: 7800138.))
((Oishi M, Fukuda M, Ishida G, Saito A, Hiraishi T, Fujii Y. Presurgical simulation with advanced 3-dimensional multifusion volumetric imaging in patients with skull base tumors. Neurosurgery. 2011 Mar;68(1 Suppl Operative):188-99; discussion 199. doi: 10.1227/NEU.0b013e318207b3ad. PMID: 21304332.))
((Sato M, Tateishi K, Murata H, Kin T, Suenaga J, Takase H, Yoneyama T, Nishii T, Tateishi U, Yamamoto T, Saito N, Inoue T, Kawahara N. Three-dimensional multimodality fusion imaging as an educational and planning tool for deep-seated meningiomas. Br J Neurosurg. 2018 Oct;32(5):509-515. doi: 10.1080/02688697.2018.1485877. Epub 2018 Jun 26. PMID: 29943649.)).
===== Videos =====
Resection of medial sphenoid wing meningiomas poses surgical challenges because of the close contact with important cerebrovascular structures. The standard treatment for large tumors is microsurgical resection. Complete removal includes maximal resection of the dura and any involved bone, but this approach is not always feasible when the tumor encases the arteries or cranial nerves. In these cases, there is evidence that a more conservative resection followed by radiation treatment can reduce operative morbidity with acceptable tumor control rates. In this 3-dimensional video (http://www.youtube.com/watch?v=owNVp-x_xOQ), the authors demonstrate their preferred technical nuances to resect a large middle to medial sphenoid wing meningioma
((Rey-Dios R, Cohen-Gadol AA. Microsurgical resection of large medial sphenoid
wing meningiomas: technique. Neurosurgery. 2013 Jun;72(2 Suppl Operative):ons183;
discussion ons183. doi: 10.1227/NEU.0b013e318288a21f. PubMed PMID: 23361325.)).

===== Case series =====

[[Medial sphenoid wing meningioma case series]].


====Case reports====

===1989===
Gum and Frueh report a case of unilateral exophthalmos and compressive optic neuropathy due to sphenoid ridge meningioma. The patient underwent transantral orbital decompression with removal of the orbital floor and medial wall that resulted in rapid, dramatic normalization of both visual acuity and visual field in the involved eye. Due to the slow-growing, noninfiltrative nature of meningiomas, we propose this procedure as an alternative, initial, palliative treatment for selected cases of compressive optic neuropathy due to meningioma compressing the posterior orbit. This procedure can provide restoration of visual function with less risk to the patient than neurosurgical resection
((Gum KB, Frueh BR. Transantral orbital decompression for compressive optic
neuropathy due to sphenoid ridge meningioma. Ophthal Plast Reconstr Surg.
1989;5(3):196-8. PubMed PMID: 2487223.
)).

===1971===
Total removal of large global meningiomas at the medial aspect of the sphenoid ridge. Technical note
((Cook AW. Total removal of large global meningiomas at the medial aspect of the
sphenoid ridge. Technical note. J Neurosurg. 1971 Jan;34(1):107-13. PubMed PMID: 
4924208.
)).