Management of Large Medial Sphenoid Wing Meningiomas: A Series of 178 Cases

AIM:The aim of this study was to evaluate our treatment and outcome in patients with large medial sphenoid wing meningiomas (SWMs). MATERIAL and METHODS: Data from 178 patients with large medial SWMs treated was collected and analyzed retrospectively. Most of patients underwent microsurgical resection under electrophysiological monitoring and Doppler probe. Radiation therapy was administered in 64 patients with residual tumor and malignant pathology. RESULTS:Total resection of the tumor was achieved in 118 of 178 cases (66.3%), subtotal in 60 of 178(33.7%) at the time of initial surgery without serious surgical complications except 2 patients with ptosis. Postoperative vision improved in 84 patients (87.5%), remained unchanged in 8 (8.3%) and deteriorated in 4 (4.2%). The progress free survival (PFS) and Karnofsky performance score (KPS) between patients with gross total resection (GTR) and patients with subtotal resection (STR) followed by radiation therapy (RT) had no significant difference. CONCLUSION: Surgery still remains a principal treatment option for SWMs. Good craniotomy techniques, proper hemostasis and optimal surgery strategy are critical to improve resection rate and elevate prognosis. Likewise, it is expected that SIR with adjuvant RT can provide satisfactory results in case of total removal impossible.