Hyperostotic sphenoid wing meningioma en plaque: proptosis management

Background: En plaque sphenoid wing meningioma is morphological unique in comparison with other intracranial meningiomas, characterized by a carpet-like usually small soft tissue component which invade the dura and extensively involve the bone specially the sphenoid wing and orbit causing significant hyperostosis. Patients & Methods: A retrospective analysis of the clinical data, neuro-radiological features, and operative techniques of eighteen patients underwent transcranio-orbital approach sphenoid wing meningioma presented with proptosis during the period from September 2011 to April 2014 in the neurosurgery department, Mansoura University. Patients age ranged from 38 years to 54 years and there was sex males and twelve females. Chief complaints were progressive proptosis and visual acuity deficits. All patients were operated up on using a fronto-temporal approach with orbital decompression. The extent of tumor resection and postoperative complications were investigated. Results: Total removal was achieved in fourteen cases (77.8%) over a mean follow-up period of 36 months. Pathological examination showed that twelve patients (66.67%) were meningothelial meningiomas. After surgery, proptosis improved in all patients, visual acuity improved in fifteen patients (83.3%). Cerebrospinal fluid leakage was found in one patient. There were no operation-related deaths or other significant complications. Four patients had residual tumor (22.2%); two of them underwent surgical re-attack of the tumor and the other two cases were sent for gamma knife radio-surgery. Conclusions: Sphenoid wing meningioma en plaque, mainly meningothelial meningiomas, are characterized by the associated bony hyperostosis that gives them a distinct radiological appearance. The bony hyperostosis is of neoplastic nature and is responsible for many of the clinical manifestation of such tumors and hence should be totally drilled to achieve cure and avoid recurrence. Extensive tumor removal is crucial for correction of proptosis and adequate visual decompression to achieve satisfactory cosmetic and functional outcome. Romanian Neurosurgery (2016) XXX 4: 498 – 506 | 499