Medial sphenoid wing meningiomas: clinical outcome and recurrence rate

OBJECTIVE: To provide clinical data concerning the visual outcome and recurrence rate of medial sphenoid wing meningiomas in consideration of two different subgroups of this tumor entity. METHODS: Among 256 sphenoid wing meningiomas, there were 108 medial sphenoid wing meningiomas of globoid shape. They were classified into Group 1 (without cavernous sinus involvement) and Group 2 (with cavernous sinus involvement). En plaque meningiomas were excluded from the analysis. The charts of the patients including surgical records, discharge letters, follow-up records, and imaging studies were analyzed retrospectively. RESULTS: There were 39 Group 1 tumors and 69 Group 2 tumors. For microsurgical tumor removal, the frontolateral (15.7%) or the pterional approach (84.3%) was performed. Total resection was achieved in 92.3% of patients with Group 1 tumors and 14.5% of those with Group 2 tumors. Radiological recurrence was observed in 7.7% (Group 1 tumors) and 27.5% (Group 2 tumors). The mean follow-up time was 79.04 months (6.59 yr). Improvement of visual function (or stable visual function) was observed in 56% (44%) of patients with Group 1 tumors, in 30% (60%) with newly diagnosed Group 2 tumors, and 10% (70%) undergoing recurrent surgery for Group 2 tumors. CONCLUSION: Group 1 meningiomas present a more favorable subgroup with fortunate visual outcome. In Group 2 tumors, visual improvement was less favorable and radical removal is limited because of cavernous sinus infiltration, with consequential higher recurrence rates. Patients harboring recurrent Group 2 tumors with deteriorating visual function profit from microsurgery because vision can be preserved on the same preoperative level in the majority.