| 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)
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.
Middle Ridge Sphenoid Wing Meningiomas
- aT, total
- RST, radical subtotal
- 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.
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.
To the MGH/MEEI/Harvard Cranial
Base Center or the MGH
Proton Beam Radiosurgery Homepage.