Meningiomas are the most common tumors of the sphenoid wing, and constitute 15–20% of all intracranial meningiomas, representing the third most common group of intracranial meningiomas. The SWMs represent a great surgical challenge due to their invasion of the bone and, especially, to their close relationship to main arteries, internal carotid artery, middle cerebral artery and cranial nerves. The different preoperative factors may significantly influence the postoperative outcome and quality of life of patients with meningiomas. Some of them are associated with a higher risk of postoperative intracranial hematoma, recurrence, blood transfusion and prolonged hospital stay. The aim of this scientific work is to improve the surgical outcome of sphenoid wing meningiomas by analysis of the different prognostic factors and the effectiveness of different surgical methods influencing the treatment results. The clinical data of 67 patients with SWM treated surgically at the Uzhhorod Regional Clinical Center for Neurosurgery and Neurology, between January 2007and January 2021, were analyzed retrospectively. The mean age of patients was 47 years, ranged from 20 to 74, median of 53.5. Mean age in the female group was 53.0 vs 57.0, in the male group (W=508.5, p=0.14). There was no statistical difference between age of male and female patients. We used surgical classic pterional approach in most cases of SWM removal. Extented pterional approach mainly was chosen for the large SWMs with skull base bone invasion or extensive PTBE. FTOZ was used in one patient. In all cases histopathologic and immune histochemical analyses were performed. Complete tumor resection was achieved in most of lateral (80.9%), middle (77.8%) and spheno-orbital meningiomas (75.0%) in contrast to 37.5% of CM (χ2=6.24, p=0.0054).The reasons for incomplete resection of sphenoid wing meningiomas are strongly related to anatomical location of SWM and tumor volume (p=0.01). The use of skull base technique with extradural anterior clinoidectomy for surgical resection of MSWM should be the preferred surgical approach due to favourable neurological outcome. Recurrence rate (16.4%) for the sphenoid wing meningiomas (mean follow-up period 87 months) is not related to age and gender. The pathological grade II (p <0.05), atypical type and Simpson grade III-V (p<0.05) are important impact factors for sphenoid wing meningioma recurrence. Weak factors include tumor volume (χ2=2.42, p=0.49), PTBE (p=0.50) and anatomical location of SWM. Time to recurrence is shorter in patients with PTBE (W=20.5, p=0.092), WHO Grade II tumors (Spearman’s p=-0.86, p=0.00063) and independent of Simpson grade surgical removal (Spearman’s=-0.15, p=0.66).
Keywords: sphenoid wing meningioma, peritumoral edema, surgical treatment, prognosis, outcome, quality of life, recurrence.
