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Management of Meningiomas

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To the Introduction and Contents of Management of Cranial and Spinal Meningiomas

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Congress of Neurological Surgeons Honored Guest Presentation
Originally Published Clinical Neurosurgery, Volume 40, Chapter 17, Pages 321-383, 1992
Used with permission of the Congress of Neurological Surgeons.

HTML Editor: Stephen B. Tatter, M.D., Ph.D.
Disclaimer: The information and reference materials contained herein are intended solely to provide background information. They were written for an audience of physicians. They are in no way intended to constitute medical advise. For medical advise a physician must, of course, be consulted.
MRI of Meningioma
FIG. 17.7. Hyperostosing sphenoid wing meningioma. This 39-year-old man had decreasing vision and increasing proptosis in his left eye. Operation, which included removal of the hyperostotic sphenoid wing, decompression of the optic nerve and second division of the trigeminal nerve, and removal of the intradural tumor, was followed by improvement in his symptoms. (A) CT axial image after contrast, showing the compression of the left orbital structures and the plaque of tumor along the dura in the anterior temporal fossa. (B) The bone windows clearly define the hyperostosis. (C) CT axial image after contrast, showing the removal of the soft tissue tumor and reconstruction with a dural graft. (D) The bone windows show the extent of the removal.



(Meningioma Management, File 6)


While MRI clearly shows the soft tissue plaque of tumor, a CT with bone windows is needed to define the extent of the hyperostosis (Fig. 17.7, A and C). Angiography is not needed.

If there is mild proptosis, it is appropriate to observe the patient. Often little change occurs over a period of many years. If the proptosis is increasing or visual loss is developing, surgery is indicated. Radiation therapy has been used in patients with visual loss due to soft tissue extension into the orbital apex.

A frontal-temporal craniotomy is utilized (26, 47). The key considerations in the operation include:

  1. Extradural exposure of the orbital roof and sphenoid wing with removal of hyperostotic bone to decompress the orbit, superior orbital fissure, and optic canal. In some patients the foramen rotundum and second division of the fifth nerve are exposed (FIG. 17.7D).
  2. Opening of the dura to remove the plaque of tumor along the sphenoid wing (Flg. 17.7B).
  3. Removal of tumor in the orbit or superior orbital fissure as needed.
  4. Repair of the dural defect with a graft of pericranial tissue.
TABLE 17.5 Hyperostosing Sphenoid Wing Meningiomas
aRemoval bOutcome Complications Recurrence
T 0 Good 16 Vision
1 1 Required reoperation
3 Given radiation therapy
for orbital apex extension
RST 0 Fair 0
ST 16 Poor 0
aT, total removal
RST, radical subtotal removal
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 16 patients, 14 women and two men, ranging in age from 33 to 74 years, with one over 70 years of age (Table 17.5). 1 could not be sure of total removal in any patient. However, removal was usually extensive. All made a good recovery. Exophthalmus improved in some patients. There were no major neurological complications except for worsened vision in one. Follow-up scans on 13 patients over 1-16 years (mean, 6.8 years) revealed no change in 12. One patient required reoperation after 4 years. Three were treated with radiation therapy for worsening vision due to tumor in the orbital apex. Their condition is stable. Brotchi and Bonnal (9) reported that of 17 patients 10 had no sequels and seven had only "slight" cranial nerve morbidity.

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