Overview

Sphenoid wing meningioma is a tumor that arises on the meninges covering the bone on the side of the skull base. From the sphenoid wing, the tumor grows towards the temporal lobe, causing significant temporal lobe brain compression and swelling or edema of the brain. The tumor tends to encase a vital brain artery (middle cerebral artery)  , which is a major branch of the carotid artery, bringing blood supply to the brain. The tumor has the potential to grow to a formidable size, causing significant temporal lobe dysfunction before coming to medical attention. 

PRESENTATION

Sphenoid wing meningioma presents with headache or disabling temporal lobe dysfunction. Temporal lobe dysfunction may include partial seizures, generalized seizures, memory changes, and personality changes. Speech difficulties can occur when the tumor is located in the dominant brain hemisphere. 

MANAGEMENT

Management of sphenoid wing meningioma requires surgery when the tumor is large, or the patient is symptomatic with temporal lobe dysfunction or seizures. Elderly patients with small tumors and minimal symptoms can be treated conservatively with surveillance MRIs. Radiation is generally not recommended for large tumors as a primary treatment to avoid unnecessary radiation to the temporal lobe of the brain.

SURGICAL DIFFICULTIES

• Size of the tumor
• Close relation to a major brain artery 
• Swelled temporal lobe covering the tumor.
• Deep location covered by the brain

SURGICAL MANAGEMENT AT THE CENTER FOR MENINGIOMA SURGERY

 At the CENTER FOR MENINGIOMA SURGERY, we conceptualized the focal orbital approach for removal of sphenoid wing meningiomas. This approach, associated with the extradural navigation concept, allows access to the tumor without hazardous exposure of the brain and only minimal direct manipulation or retraction of it. In selected cases, the focal orbital approach can be done through a small eyebrow incision. The approach allows for early control of the blood supply to the tumor and full and early identification for safe control of the carotid artery and its main branches.  The approach offers maximal potential for complete resection of the tumor, including its meningeal roots.

Prognosis

Full or partial recovery of severe temporal lobe dysfunction is possible with adequate surgical management of sphenoid wing meningioma using the focal orbital approach conceptualized at the Center for Meningioma Surgery. Moreover, the patients have the potential for returning to their pre-morbid lifestyle and job occupation. Maximal removal of the tumor and its meningeal root maximizes the chances of cure without tumor recurrence.