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Management of Meningiomas
File 5: MIDDLE RIDGE SPHENOID WING MENIGIOMAS

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by ROBERT G. OJEMANN, M.D.
© Congress of Neurological Surgeons Honored Guest Presentation
Originally Published Clinical Neurosurgery, Volume 40, Chapter 17, Pages 321-383, 1992
Used with permission of the Congress of Neurological Surgeons.
HTML Editor: Stephen B. Tatter, M.D., Ph.D.
Disclaimer: The information and reference materials contained herein are intended solely to provide background information. They were written for an audience of physicians. They are in no way intended to constitute medical advise. For medical advise a physician must, of course, be consulted.

Contents

References (File 22)

  • MRI of Meningioma
    FIG. 17.6. Middle ridge sphenoid wing meningioma. This 70-year-old woman had increasing headache and a seizure. A normal recovery and complete relief of the headache followed removal of the tumor. (A) The MRI axial T1 image after gadolinium defines the extent of the right-side tumor. (B) The MRI axial T2 image shows the edema in the adjacent brain areas and shows that the middle cerebral artery branches are separate from the tumor. Angiography is not needed.

    MIDDLE RIDGE SPHENOID WING MENIGIOMAS

    (Meningioma Management, File 5)

    Management

    Middle ridge meningiomas straddle the middle portion of the sphenoid wing and compress, to varying degrees, both the frontal and temporal lobes. The diagnosis is established by MRI (Fig. 17.6). Angiography is not needed and there has been no indication for embolization. The indications for surgery are usually headache or seizures. Radiation therapy has not been used.

    The approach is a frontal-temporal craniotomy, as described for tuberculum sellae meningiomas. In some patients increased temporal exposure is needed. Usually a complete removal can be done.

    The key considerations in the operation are those outlined for meningiomas in general (see File 1). There is usually a well defined dural attachment and the blood supply from the meningeal artery coming in along the base should be occluded early in the course of the operation. In large tumors the middle cerebral artery branches may need to be separated from the tumor capsule.

    • TABLE 17.4 Middle Ridge Sphenoid Wing Meningiomas
      aRemoval bOutcome Complications Recurrence
      T 7 Good 7 None None
      RST 0 Fair 0
      ST 0 Poor 0
      aT, total removal
      RST, radical subtotal removal
      ST, subtotal removal
      bGood, free of major neurological deficit
      and able to return to previous activity level
      Fair, independent but not able to return to full activity
      because of new neurological deficit or significant
      preoperative deficit that did not fully recover
      Poor, dependent.

    Results

    There were three women and four men ranging in age from 24 to 73 years, with two over 70 years of age (Table 17.4). All seven patients had complete removal of the tumor, there were no complications, and they returned to full activity. There has been no recurrence. Brotchi and Bonnal (9) reported the same results with nine patients.



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