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Zheng K, Murphy MC, Camerucci E, Plitt AR, Shan X, Sui Y, Manduca A, Van Gompel JJ, Ehman RL, Huston J, Yin Z. Improved quantification of tumor adhesion in meningiomas using MR elastography-based slip interface imaging. PLoS One 2024; 19:e0305247. [PMID: 38917107 PMCID: PMC11198761 DOI: 10.1371/journal.pone.0305247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Meningiomas, the most prevalent primary benign intracranial tumors, often exhibit complicated levels of adhesion to adjacent normal tissues, significantly influencing resection and causing postoperative complications. Surgery remains the primary therapeutic approach, and when combined with adjuvant radiotherapy, it effectively controls residual tumors and reduces tumor recurrence when complete removal may cause a neurologic deficit. Previous studies have indicated that slip interface imaging (SII) techniques based on MR elastography (MRE) have promise as a method for sensitively determining the presence of tumor-brain adhesion. In this study, we developed and tested an improved algorithm for assessing tumor-brain adhesion, based on recognition of patterns in MRE-derived normalized octahedral shear strain (NOSS) images. The primary goal was to quantify the tumor interfaces at higher risk for adhesion, offering a precise and objective method to assess meningioma adhesions in 52 meningioma patients. We also investigated the predictive value of MRE-assessed tumor adhesion in meningioma recurrence. Our findings highlight the effectiveness of the improved SII technique in distinguishing the adhesion degrees, particularly complete adhesion. Statistical analysis revealed significant differences in adhesion percentages between complete and partial adherent tumors (p = 0.005), and complete and non-adherent tumors (p<0.001). The improved technique demonstrated superior discriminatory ability in identifying tumor adhesion patterns compared to the previously described algorithm, with an AUC of 0.86 vs. 0.72 for distinguishing complete adhesion from others (p = 0.037), and an AUC of 0.72 vs. 0.67 for non-adherent and others. Aggressive tumors exhibiting atypical features showed significantly higher adhesion percentages in recurrence group compared to non-recurrence group (p = 0.042). This study validates the efficacy of the improved SII technique in quantifying meningioma adhesions and demonstrates its potential to affect clinical decision-making. The reliability of the technique, coupled with potential to help predict meningioma recurrence, particularly in aggressive tumor subsets, highlights its promise in guiding treatment strategies.
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Affiliation(s)
- Keni Zheng
- Radiology, Mayo Clinic, Rochester, MN, United States of America
| | | | | | - Aaron R. Plitt
- Neurosurgery, Mayo Clinic, Rochester, MN, United States of America
| | - Xiang Shan
- Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Yi Sui
- Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Armando Manduca
- Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States of America
| | - Jamie J. Van Gompel
- Neurosurgery, Mayo Clinic, Rochester, MN, United States of America
- Otolaryngology, Mayo Clinic, Rochester, MN, United States of America
| | | | - John Huston
- Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Ziying Yin
- Radiology, Mayo Clinic, Rochester, MN, United States of America
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Nassar A, Smolanka V, Smolanka A, Chaulagain D, Devinyak O. Sphenoid wing meningiomas: peritumoral brain edema as a prognostic factor in surgical outcome. Neurosurg Rev 2022; 45:2951-2959. [PMID: 35624342 DOI: 10.1007/s10143-022-01816-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/03/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022]
Abstract
Sphenoidal meningiomas constitute 18% of intracranial masses, and still present a difficult surgical challenge. PTBE has been associated with several complications and future recurrence. This study aims to evaluate the outcome of the operatively treated sphenoid wing meningiomas in relation to PTBE as a prognostic factor in a series of 65 patients. The clinical materials of 65 patients with SWM treated microsurgically between 2007 and 2020 were analyzed retrospectively. Follow-up ranged from 6 to 156 months (median, 86). Clinical outcomes include postoperative major neurological deficit, quality of life using KPS, recurrence, and mortality rates. The mean age of patients was 53.9 years (range 20-74), males 24.6% and females75.4%. An edema index (EI) of 1 (40%) was considered as absent edema, and EI > 1 (60%) indicated present edema. Total resection (Simpson I-II) was achieved in 64.6% and subtotal (Simpson IV) in 13.8%. Postoperative complications included vision impairment in 3 patients, motor weakness 6, third nerve palsy 6, intraoperative bleeding and edema 5, and MCA infarct 2, recurrence in 17% and 7.7% died. In univariate analysis, we found that the PTBE is one of the serious risk factors in the immediate surgical outcomes and complication, though more data is needed to support this claim, while having a negative effect on postoperative KPS at short-term follow up (χ2 = 6.44, p = 0.011). PTBE was associated with decline in KPS and quality of life in the early postoperative period (three months) while showing no significant effect at long-term outcomes.
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Affiliation(s)
- Abdalrahman Nassar
- Uzhhorod Regional Center of Neurosurgery and Neurology, Uzhhorod National University, Uzhhorod, Ukraine.
| | - Volodymyr Smolanka
- Uzhhorod Regional Center of Neurosurgery and Neurology, Uzhhorod National University, Uzhhorod, Ukraine
| | - Andriy Smolanka
- Uzhhorod Regional Center of Neurosurgery and Neurology, Uzhhorod National University, Uzhhorod, Ukraine
| | - Dipak Chaulagain
- Uzhhorod Regional Center of Neurosurgery and Neurology, Uzhhorod National University, Uzhhorod, Ukraine
| | - Oleg Devinyak
- Department of Pharmacy, Uzhhorod National University, Uzhhorod, Ukraine
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Seaman SC, Zanaty M, Crompton D, Piscopo A, Ankrah NK, Buatti JM, Greenlee JDW, Howard MA. Case series of sphenoid wing meningioma - What is a maximal safe resection? Neurochirurgie 2021; 67:547-555. [PMID: 34051247 DOI: 10.1016/j.neuchi.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/05/2021] [Accepted: 05/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sphenoid wing meningiomas are a challenging surgical disease with relatively high perioperative morbidity. Most studies to date have focused on resection strategies as it relates to disease recurrence. Few have examined the optimal strategy as it relates to overall patient survival. We retrospectively reviewed our case series and evaluated extent of resection and perioperative stroke as it relates to all cause and disease-specific survival. PATIENTS/METHODS Ninety-four patients were included in the study. Demographics, clinical features, operative features and clinical course, and time to mortality evaluation were collected. Extent of resection (EOR) was defined as gross total (GTR, 100%), near total (NTR, ≥ 95%), and subtotal (STR,<95%). RESULTS The overall mean EOR was 94.5% with 70.2% of cases achieving GTR, 12.8% achieved NTR, and 17% achieved STR. Postoperative stroke only occurred with GTR or NTR (p=0.041). Age alone was significant on Cox regression analysis for all cause mortality (p=0.042, HR 1.054 [95% CI 1.002 - 1.109]). Postoperative stroke was associated with worse disease-specific mortality (p=0.046, HR 23.337 [95% CI 1.052 - 517.782) with no impact from extent of resection (p=0.258). CONCLUSIONS Although maximizing resection and minimizing recurrence is ideal, GTR or NTR confer a significantly higher stroke risk. Most patients do not die from their meningioma, as all cause mortality was associated only with age. However, perioperative stroke conferred decreased survival throughout follow up. This series demonstrates that an overly aggressive surgical philosophy negatively impacted disease specific survival.
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Affiliation(s)
- Scott C Seaman
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 52242 Iowa City, Iowa, USA.
| | - Mario Zanaty
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 52242 Iowa City, Iowa, USA
| | - David Crompton
- University of Iowa Carver College of Medicine, 200 Hawkins Drive, 52242 Iowa City, Iowa, USA
| | - Anthony Piscopo
- University of Iowa Carver College of Medicine, 200 Hawkins Drive, 52242 Iowa City, Iowa, USA
| | - Nii-Kwanche Ankrah
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 52242 Iowa City, Iowa, USA
| | - John M Buatti
- Department of Radiation Oncology, 200 Hawkins Drive, 52242 Iowa City, Iowa, USA
| | - Jeremy D W Greenlee
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 52242 Iowa City, Iowa, USA
| | - Matthew A Howard
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 52242 Iowa City, Iowa, USA.
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Yin Z, Lu X, Cohen Cohen S, Sui Y, Manduca A, Van Gompel JJ, Ehman RL, Huston J. A new method for quantification and 3D visualization of brain tumor adhesion using slip interface imaging in patients with meningiomas. Eur Radiol 2021; 31:5554-5564. [PMID: 33852045 DOI: 10.1007/s00330-021-07918-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/12/2021] [Accepted: 03/19/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To develop an objective quantitative method to characterize and visualize meningioma-brain adhesion using MR elastography (MRE)-based slip interface imaging (SII). METHODS This retrospective study included 47 meningiomas (training dataset: n = 35; testing dataset: n = 12) with MRE/SII examinations. Normalized octahedral shear strain (NOSS) values were calculated from the acquired MRE displacement data. The change in NOSS at the tumor boundary (ΔNOSSbdy) was computed, from which a 3D ΔNOSSbdy map of the tumor surface was created and the probability distribution of ΔNOSSbdy over the entire tumor surface was calculated. Statistical features were calculated from the probability histogram. After eliminating highly correlated features, the capability of the remaining feature for tumor adhesion classification was assessed using a one-way ANOVA and ROC analysis. RESULTS The magnitude and location of the tumor adhesion can be visualized by the reconstructed 3D ΔNOSSbdy surface map. The entropy of the ΔNOSSbdy histogram was significantly different between adherent tumors and partially/completely non-adherent tumors in both the training (AUC: 0.971) and testing datasets (AUC: 0.900). Based on the cutoff values obtained from the training set, the ΔNOSSbdy entropy in the testing dataset yielded an accuracy of 0.83 for distinguishing adherent versus partially/non-adherent tumors, and 0.67 for distinguishing non-adherent versus completely/partially adherent tumors. CONCLUSIONS SII-derived ΔNOSSbdy values are useful for quantification and classification of meningioma-brain adhesion. The reconstructed 3D ΔNOSSbdy surface map presents the state and location of tumor adhesion in a "clinician-friendly" manner, and can identify meningiomas with a high risk of adhesion to adjacent brain parenchyma. KEY POINTS • MR elastography (MRE)-based slip interface imaging shows promise as an objective tool to preoperatively discriminate meningiomas with a high risk of intraoperative adhesion. • Measurement of the change of shear strain at meningioma boundaries can provide quantitative metrics depicting the state of adhesion at the tumor-brain interface. • The surface map of tumor adhesion shows promise in assisting precise adhesion localization, using a comprehensible, "clinician-friendly" 3D visualization.
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Affiliation(s)
- Ziying Yin
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA.
| | - Xin Lu
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA
| | | | - Yi Sui
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA
| | - Armando Manduca
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Jamie J Van Gompel
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.,Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA
| | - John Huston
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA
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Loewenstern J, Aggarwal A, Pain M, Barthélemy E, Costa A, Bederson J, Shrivastava RK. Peritumoral Edema Relative to Meningioma Size Predicts Functional Outcomes after Resection in Older Patients. Oper Neurosurg (Hagerstown) 2020; 16:281-291. [PMID: 29790982 DOI: 10.1093/ons/opy107] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/10/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Resection of meningiomas in older adults is associated with increased complications and postoperative functional deficits. Extent of peritumoral edema (PTE), which has been associated with surgical prognosis, may represent a preoperative risk marker for poorer outcomes in older adults. OBJECTIVE To quantitatively evaluate the relationship between preoperative PTE and postresection outcomes in older meningioma patients. METHODS One hundred twelve older meningioma patients (age ≥ 60) with evidence of PTE on MRI were reviewed. Extent of PTE, measured as a ratio of edema to tumor volume (edema index, EI) using semiautomatic image-processing software, was correlated with postresection outcomes. Other preoperative factors were included as covariates in multivariate analyses. Results were compared to matched nonedema older patients. Receiver operating characteristic (ROC) curve analysis was performed to identify cut-off EI values to predict postoperative outcomes. RESULTS EI was associated with functional decline (as measured by Karnofsky Performance Status, KPS) at 6 mo, 1, 2 yr, and most recent follow-up (Ps < .05), but not among the nonedema matched patients. Seizure or prior stroke additionally trended towards increasing the likelihood of lower KPS at 2 yr (odds ratio = 3.06) and last follow-up (odds ratio = 5.55), respectively. ROC curve analysis found optimal cut-off values for EI ranging from 2.01 to 3.37 to predict lower KPS at each follow-up interval. Sensitivities ranged from 60% to 80%, specificities from 78% to 89%, and positive and negative predictive values from 38% to 58% and 80% to 97%. CONCLUSION Preoperative PTE may represent a significant marker of poor functional outcome risk in older adults and provides a quantitative measurement to incorporate into surgical decision-making.
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Affiliation(s)
- Joshua Loewenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amit Aggarwal
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Margaret Pain
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ernest Barthélemy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anthony Costa
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
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Toro ED, Risbud A, Khosravani N, Vengerovich G, Archilla A. Sphenoid Wing Meningioma Presenting as Sudden Sensorineural Hearing Loss: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2020; 100:352S-355S. [PMID: 32050788 DOI: 10.1177/0145561320905731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sphenoid wing meningiomas are tumors that typically present with vision deterioration and neurological changes due to their proximity to the sella, cavernous sinus, and other vital structures. Some unusual symptoms have also been described in the literature, such as cognitive dysfunction, parkinsonism, and intracerebral hemorrhage. In this report, we detail another unusual case of sphenoid wing meningioma in a 63-year-old female who presented with left sudden sensorineural hearing loss. A brief review of the literature is also included.
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Affiliation(s)
- Edgar Del Toro
- Department of Surgery, University of Miami/21622JFK Medical Center Palm Beach, Atlantis, FL, USA
| | - Adwight Risbud
- 12235Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Nima Khosravani
- Department of Surgery, University of Miami/21622JFK Medical Center Palm Beach, Atlantis, FL, USA
| | - Gennadiy Vengerovich
- Department of Surgery, University of Miami/21622JFK Medical Center Palm Beach, Atlantis, FL, USA
| | - Alfredo Archilla
- Department of Surgery, University of Miami/21622JFK Medical Center Palm Beach, Atlantis, FL, USA
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Champagne PO, Lemoine E, Bojanowski MW. Surgical management of giant sphenoid wing meningiomas encasing major cerebral arteries. Neurosurg Focus 2019; 44:E12. [PMID: 29606042 DOI: 10.3171/2018.1.focus17718] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sphenoid wing meningiomas are a heterogeneous group of tumors with variable surgical risks and prognosis. Those that have grown to a very large size, encasing the major cerebral arteries, are associated with a high risk of stroke. In reviewing the authors' series of giant sphenoid wing meningiomas, the goal was to evaluate how the extent of the tumor's invasion of surrounding structures affected the ability to safely remove the tumor and restore function. METHODS The authors conducted a retrospective study of a series of giant sphenoid wing meningiomas operated on between 1996 and 2016. Inclusion criteria were meningiomas with a globoid component ≥ 6 cm, encasing at least 1 major intradural cerebral artery. Extent of resection was measured according to Simpson grade. RESULTS This series included 12 patients, with a mean age of 59 years. Visual symptoms were the most common clinical presentation. There was complete or partial encasement of all 3 major cerebral arteries except for 3 cases in which only the anterior cerebral artery was not involved. The lateral wall of the cavernous sinus was invaded in 8 cases (67%) and the optic canal in 6 (50%). Complete resection was achieved in 2 cases (Simpson grades 2 and 3). In the remaining 10 cases of partial resection (Simpson grade 4), radical removal (> 90%) was achieved in 7 cases (70%). In the immediate postoperative period, there were no deaths. Four of 9 patients with visual deficits improved, while the 5 others remained unchanged. Two patients experienced transient neurological deficits. Other than an asymptomatic lacuna of the internal capsule, there were no ischemic lesions following surgery. Tumor recurrence occurred in 5 patients, between 24 and 168 months (mean 61 months) following surgery. CONCLUSIONS Although these giant lesions encasing major cerebral arteries are particularly treacherous for surgery, this series demonstrates that it is possible to safely achieve radical removal and at times even gross-total resection. However, the risk of recurrence remains high and larger studies are needed to see if and how improvement can be achieved, whether in surgical technique or technological advances, and by determining the timing and modality of adjuvant radiation therapy.
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8
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Sphenoid Wing Meningiomas: Surgical Outcomes in a Series of 141 Cases and Proposal of a Scoring System Predicting Extent of Resection. World Neurosurg 2019; 125:e48-e59. [DOI: 10.1016/j.wneu.2018.12.175] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022]
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9
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Campero A, Villalonga JF, Elizalde RL, Ajler P, Martins C. Transzygomatic approach plus mini-peeling of middle fossa for devascularization of sphenoid wing meningiomas. Technical note. Surg Neurol Int 2018; 9:140. [PMID: 30105134 PMCID: PMC6069374 DOI: 10.4103/sni.sni_135_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/18/2018] [Indexed: 11/06/2022] Open
Abstract
Background: Sphenoid wing meningiomas account for 20% of supratentorial meningiomas. The main supply of these tumors is provided by branches of the middle and accessory meningeal arteries. Surgical resection of meningiomas requires early tumor devascularization. Our objective is to present the role of transzygomatic approach plus mini-peeling of the anterior third of the middle fossa in the extradural identification and coagulation of branches of middle and accessory meningeal arteries involved in tumor supply. Methods: Ten formalin-fixed, silicone-injected cadaveric heads were used. On each side a transzygomatic approach plus mini-peeling of the anterior third of the middle fossa was performed. Between 2005 and 2017, the authors applied this technique for the resection of sphenoid wing meningiomas in 28 patients. Results: The mean age of patients was 54 years. Thirteen tumors could be classified as medial-third type, 6 as middle-third type, and 4 tumors were lateral-third type. Five tumors represented combined types. Of these, 3 tumors involved the medial and middle-third of the sphenoid wing and 2 involved the entire wing. Surgical resection was classified as Simpson I/II in 24 patients (86%). There were no permanent deficits or postoperative mortality. Conclusions: The transzygomatic approach combined with mini-peeling of the anterior third of the middle fossa is effective in allowing early devascularization of sphenoid wing meningiomas. These maneuvers are particularly important during resection of large tumors.
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Affiliation(s)
- Alvaro Campero
- Department of Neurosurgery, Hospital Padilla, Tucuman, Argentina.,Universidad Nacional de Tucuman, Argentina
| | | | | | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Argentina
| | - Carolina Martins
- Department of Neurosurgery, Hospital Metropolitano Oesta Pelópidas Silveira, Recife, Brasil
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10
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Surgical Management of Tumors Involving Meckel's Cave and Cavernous Sinus: Role of an Extended Middle Fossa and Lateral Sphenoidectomy Approach. Otol Neurotol 2018; 39:82-91. [PMID: 29135804 DOI: 10.1097/mao.0000000000001602] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the indications and outcomes of lateral sphenoidectomy as part of a combined skull base approach in the treatment of tumors involving Meckel's cave (MC) and cavernous sinus (CS). STUDY DESIGN Retrospective patient series. SETTING Tertiary referral center. PATIENTS Twenty-two consecutive patients (mean age: 45 yr, range: 16-76) who underwent transzygomatic, extended middle fossa approaches for tumors involving MC and CS. INTERVENTIONS Surgical access to MC and CS was achieved via extended middle fossa, trans-clinoid approach. Lateral sphenoidectomy was defined as drill-out of the greater sphenoid wing lateral to foramen rotundum and ovale, decompression of superior orbital fissure, and removal of anterior clinoid process. Reconstruction was achieved using combination of autologous and synthetic materials. Eleven patients (50%) received adjuvant radiation. MAIN OUTCOME MEASURES AND RESULTS Tumor pathologies included meningioma (16 patients), epidermoid cyst (2), trigeminal schwannoma (2), invasive pituitary adenoma (1), and chondrosarcoma (1). Mean (range) preoperative tumor size was 4.0 cm (1.3-9). Mean (range) length of follow-up was 4 years (range 0.1-10). Overall tumor control and gross total resection were achieved in 95 and 23% of patients, respectively. Lateral sphenoidectomy was performed in 16 patients (73%) for enhanced surgical access and/or tumor extension to the infratemporal fossa (6 patients). Postoperatively, cranial nerve deficits occurred in 12 (55%) patients (V-9 patients; III, IV, or VI-4; VII-2; VIII-2). Cerebrospinal fluid leak and hydrocephalus occurred in two and four patients, respectively. CONCLUSION In combination with middle fossa-based approaches to tumors involving MC and CS, lateral sphenoidectomy may play a viable role in tumor access and control.
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McCracken DJ, Higginbotham RA, Boulter JH, Liu Y, Wells JA, Halani SH, Saindane AM, Oyesiku NM, Barrow DL, Olson JJ. Degree of Vascular Encasement in Sphenoid Wing Meningiomas Predicts Postoperative Ischemic Complications. Neurosurgery 2018; 80:957-966. [PMID: 28327941 DOI: 10.1093/neuros/nyw134] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/18/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Sphenoid wing meningiomas (SWMs) can encase arteries of the circle of Willis, increasing their susceptibility to intraoperative vascular injury and severe ischemic complications. OBJECTIVE To demonstrate the effect of circumferential vascular encasement in SWM on postoperative ischemia. METHODS A retrospective review of 75 patients surgically treated for SWM from 2009 to 2015 was undertaken to determine the degree of circumferential vascular encasement (0°-360°) as assessed by preoperative magnetic resonance imaging (MRI). A novel grading system describing "maximum" and "total" arterial encasement scores was created. Postoperative MRIs were reviewed for total ischemia volume measured on sequential diffusion-weighted images. RESULTS Of the 75 patients, 89.3% had some degree of vascular involvement with a median maximum encasement score of 3.0 (2.0-3.0) in the internal carotid artery (ICA), M1, M2, and A1 segments; 76% of patients had some degree of ischemia with median infarct volume of 3.75 cm 3 (0.81-9.3 cm 3 ). Univariate analysis determined risk factors associated with larger infarction volume, which were encasement of the supraclinoid ICA ( P < .001), M1 segment ( P < .001), A1 segment ( P = .015), and diabetes ( P = .019). As the maximum encasement score increased from 1 to 5 in each of the significant arterial segments, so did mean and median infarction volume ( P < .001). Risk for devastating ischemic injury >62 cm 3 was found when the ICA, M1, and A1 vessels all had ≥360° involvement ( P = .001). Residual tumor was associated with smaller infarct volumes ( P = .022). As infarction volume increased, so did modified Rankin Score at discharge ( P = .025). CONCLUSION Subtotal resection should be considered in SWM with significant vascular encasement of proximal arteries to limit postoperative ischemic complications.
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Affiliation(s)
- D Jay McCracken
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | | | | | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - John A Wells
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Amit M Saindane
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | | | - Daniel L Barrow
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University, Atlanta, Georgia
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12
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Shan B, Zhang J, Xu J. Letter to the Editor. Function outcome related to aggressive surgery for meningioma? J Neurosurg 2017; 128:654-655. [PMID: 29271719 DOI: 10.3171/2017.6.jns171089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Bir SC, Maiti T, Konar S, Nanda A. Comparison of the Surgical Outcome of Pterional and Frontotemporal-Orbitozygomatic Approaches and Determination of Predictors of Recurrence for Sphenoid Wing Meningiomas. World Neurosurg 2017; 99:308-319. [DOI: 10.1016/j.wneu.2016.10.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 10/07/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
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14
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Surgical anatomy of the cavernous sinus, superior orbital fissure, and orbital apex via a lateral orbitotomy approach: a cadaveric anatomical study. Acta Neurochir (Wien) 2016; 158:2135-2148. [PMID: 27614437 DOI: 10.1007/s00701-016-2940-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tumors of the middle fossa or cavernous sinus (CS), or intraorbital tumors, can penetrate each other through the superior orbital fissure (SOF) or neighboring tissue. These complicated pathologies are often treated with highly invasive surgical procedures. In this article, we demonstrate surgical anatomic dissections of the CS, SOF, orbital apex (OA), and dura mater extending to the periorbita from the middle fossa, by performing an epidural dissection via a lateral orbitotomy approach, and discuss findings that may provide guidance during surgery in these regions. METHODS Lateral orbitotomy was performed on latex-injected cadaver heads by making a 2-cm skin incision lateral to the lateral canthus, drilling the lesser and greater sphenoid wings that form the SOF borders, and removing the bone section between the middle fossa and orbit. Dura mater from the middle fossa to the periorbita was exposed to perform anterior clinoidectomy. Meningeal dura was dissected from the endosteal dura, which forms the lateral wall of the CS, to expose the CS, SOF, and OA for dissections. RESULTS Changing the orientation of the microscope from posterior to anterior enabled regional control for dissection from the Gasserian ganglion to the OA. Cranial nerves that pass through the CS, SOF, and OA were dissected and exposed. The annular tendon was opened, revealing the oculomotor nerves and its branches, as well as the abducens and nasociliary nerves, which pass through the oculomotor foramen and course within the OA and orbit. CONCLUSIONS This approach causes less tissue damage; provides control of the surgical area in spheno-orbital tumors invading the fissure and foramen by changing the orientation of the microscope toward the orbit, OA, SOF, CS, and middle fossa; and expands the indication criteria for lateral orbitotomy surgery. This approach, therefore, represents an alternative surgical method for excising complicated tumors in these regions.
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Mohme M, Emami P, Matschke J, Regelsberger J, Westphal M, Eicker SO. Secretory Meningiomas. Neurosurg Clin N Am 2016; 27:181-7. [DOI: 10.1016/j.nec.2015.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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