Outcome of Sphenoid Wing En Plaque Meningioma Surgery

Background: Sphenoid wing en plaque meningiomas are complex tumours involving the sphenoid wing, the orbit, and sometimes the cavernous sinus. Complete removal is difficult, so these tumours have high rates of recurrence and postoperative morbidity. Objective: In this study the extent of tumour resection and postoperative complications in patients with meningioma en plaque were investigated. Patients and Methods: A retrospective study was made on clinical manifestations, neuroradiological features, and operative techniques in nine patients undergoing transcranio-orbital approach for sphenoid wing en plaque meningioma resection from January 2011 through December 2014. Patients ages ranged from 16 years to 67 years; 45.5 years in average. There were two males and seven females. The main complaints were progressive proptosis and visual acuity deficits. All patients were operated on using a fronto-temporal approach with orbital decompression. Results: Simpson grade II resection was achieved in three patients, Simpson grade III in six patients. Pathological examination showed that seven (77.8%) patients had meningothelial meningiomas. After surgery, proptosis improved in six patients (66.7%) while visual acuity improved in three patients (42.9%). Temporary ophthalmoplegia was found in three patients and cerebrospinal fluid leak was found in one patient. Duration of follow up was from 3 months to 3 years. Three patients showed progressive growth of the remaining tumor. There were no mortalities in this study. Conclusions: Sphenoid wing en plaque meningiomas are more likely to produce adjacent hyperostosis. All the hyperostotic bone of the great wing of sphenoid bone should be removed to minimise incidence of regrowth or recurrence. Extensive tumor removal with bony decompression at the orbital apex can produce satisfactory cosmetic and functional outcome.