Background: Sphenoid wing meningioma en plaque is a
unique subtype of intracranial meningiomas, known as intra
osseous meningiomas that specifically grow at the base of
the anterior and middle cranial fossa, extending to the sphenoid
wing and orbit and associated with a significant hyperostosis.
They result in neurosurgical complications by direct pressure
of nearby cranial nerves, cavernous sinus and carotid artery.
Aim of Study: Present our series of Sphenoid wing meningioma
en plaque and to try to conclude the best surgical
options and promising results.
Patients and Methods: Retrospective analysis for our
records regarding 22 patients with radiologically and pathologically
proven en plaque meningioma from Jan 2016 to Nov
2019. All patients underwent complete neurological examination
with detailed ophthalmic examination was performed.
We adopted the pterional approach with its modification for
all surgeries. Post operative CT scan was performed to asses
degree of excision and possible recurrence.
Results: Mean age was 42 years 21 were females and 1
male. The most common presenting symptom was proptosis
in 20 (93%) patients and also 6 patients presented with visual
affection (27%). 7 patients complained of peri-orbital pain.
5 patients observed solid swelling over the Temple region We
could remove the tumors in most of cases totally Up to grade
II on Simpson scale. In 5 out of 22 cases, the resection was
subtotal. Improved Proptosis in 17 out of 22 patients post
operative. Adjuvant radiation therapy was performed in 5
patients. After a mean follow-up of 24 monthes, 4 out of 22
patients presented by tumor recurrence (18,2%) the recurrences
were mainly in the areas around the superior orbital fissure
due to our inability to resect the tumor completely for fear of
complications and exposed to another course of radiotherapy,
No patient presented recurrence after radiation therapy.
Conclusion: Early diagnosis, prompt surgical intervention
with resection of all invaded bone as possible are key factors
in improving outcome of spheno-orbital meningioma en
plaque. Regular follow-up is mandatory as some cases may
have unpredictable behavior. |
