Sphenoid wing meningioma surgery
Microsurgery may be the most effective method for the large and giant medial sphenoid wing meningiomas 1).
Once the tumor is exposed a partial internal debulking is performed. Then the point of attachment (to the sphenoid bone) is peeled away using bipolar cautery to divide feeding vessels. Then the main portion of the tumor may be separated from the brain, with the tumor being avascular once the vascular pedicle has been transected.
Some sphenoid wing meningiomas are associated with a significant hyperostosis of the adjacent sphenoid ridge that may even exceed the size of the intradural mass. The decision-making process and surgical planning based on neuroanatomic knowledge are the mainstays of management of this group of lesions. Given their natural history and biologic behavior, many hyperostosing meningiomas at this location require long-term management analogous to a chronic disease. This is particularly true when making initial decisions regarding treatment and planning surgical intervention, when it is important to take into consideration the possibility of further future interventions during the patient's life span 2).
Videos
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https://jomi.com/article/143/resection-sphenoid-wing-meningioma
Position
The neck is extended to allow gravity to retract the brain of the floor of the skull.
Craniotomy
A pterional craniotomy for sphenoid wing meningioma is utilized. Most medial sphenoid wing meningiomas can be resected through the extended pterional craniotomy. If the lesion harbors a significant suprasellar component, the orbitozygomatic craniotomy affords an excellent exposure of the suprasellar extent of the tumor with minimal frontal lobe retraction.
Approaches
Lateral sphenoid wing meningiomas: The approach to these tumors is often similar to convexity meningiomas. The height of the skin incision and bone opening should be high enough to encompass the tumor.
González-Darder JM. Combined Extradural and Intradural Pterional Transzygomatic Approach to Large Sphenoid Wing Meningiomas. Operative Technique and Surgical Results. J Neurol Surg B Skull Base. 2019 Jun;80(3):244-251. doi: 10.1055/s-0038-1668538. Epub 2018 Aug 21. PubMed PMID: 31143566; PubMed Central PMCID: PMC6534744.
Lateral Orbitotomy Approach for Resection of Intraosseous Sphenoid Wing Meningioma: 3-Dimensional Operative Video 3).
see Lateral transzygomatic approach