gms | German Medical Science

Objective: Since the first description by Harvey Cushing, a substantial amount of information has been gathered on sphenoid wing meningiomas but there has not been a practival and informative novel classification scheme to accompany these clinical advancements. Although several different types of meningiomas were once considered together, clinoidal, cavernous sinus or sphenoorbital or sphenopetroclival meningiomas are now considered separate clinical entities.

Method: Sphenoid wing meningiomas operated by one single neurosurgeon from 1986 to 2013 were included in the study. Clinoidal meningiomas or other meningiomas with no certain epicenter were excluded. Radiological findings (tumor origin and size, bone invasion, vascular invasion and narroving), operative findings (bone invasion, proximal or distal vascular invasion), histopathology, adjuvant therapies (radiosurgery, radiation therapy) and surgical results (extent of resection, complication rate, mortality, long-term morbidity, recurrence rate) were taken into consideration for the analysis.

Results: A total of 108 patients were included in the analysis. 70% were male and 30% were females. The median age was 56, ranging from 20 to 90 years. 52.6% were located in the inner, 26.3 in the middle and 19.3 in the outer third. Severe edema with midline shift was seen in 49%. The median tumor volume was 32cm³ (range 2–202). Secondary bony changes were seen in 45.8 and orbital invasion in 20%. Proximal and distal vascular invasion was observed in 6.6 and 29.3% respectively. Gross total resection was obtained in 74.2% of surgeries. The median follow-up was 8 years. Localization along the sphenoid ridge was not correlated with clinical outcome. Proximal and distal vascular invasion, bone invasion and the tumor size were the most important parameters that correlated with recurrence and patient outcome.

Conclusions: There are several weaknesses of current classification schemes and there are also some characteristics that do not correlate with either surgical results and long-term outcome. Therefore a novel classification scheme is proposed.