Microsurgical Operation And Gamma Knife Radiosurgery For Medial Sphenoid Wing Meningioma

Objective : To explore the efectiveness of microsurgery and Gamma knife radiosurgery for medial sphenoid wing meningiomas.Methods:39 cases of medial sphenoid wing meningiomas, admitted into our department from March 2008 to December 2015 and undergoing operations, were retrospectively analyzed.30 cases were used by the pterional approach or modified pterional approach, 5 cases by the subfrontal approach, 4 cases by the fronto-temporo-orbito-zygomatic approach(FTOZA). 8 cases of subtotal or partial resection and 5 case of recurred tumors were treated with Gamma knife radiosurgery.Results:In this study, total resection(Simpson Grade I or II) was achieved in 69.2%; subtotal resection(Simpson Grade ?) in 20.5%; partial resection(Simpson Grade ?) in 10.3%. 8 cases of incomplete tumor removal received Gamma knife radiosurgery after surgery and tumor control rate was 75%. 5 cases of recurred tumor underwent Gamma knife,the tumor control rate was 60%. In 39 patients followed up for 6 months to 8 years(mean 45 months), the recovery was good in 32 patients, fair in 4, and poor in 3, and one patient died.In 21 patients with preoperative vision and visual field disorders, 7 patients were markedly improved, 9 patients unchanged and 5 worsened postoperatively.In 7 patients with preoperative hemiplegia and hemidysesthesia, 6 patients were improved and 1 worsened postoperatively.In 6 patients with preoperative oculomoter nerve palsy, 1 patients were markedly improved, 2 patients unchanged and 3 worsened postoperatively. New deficits in cranial nerve III occurred in 6 cases and hemiplegia in 1 cases, transiently impaired consciousness in 3, neuropsychiatric symptoms in 1, aphasia in 1 and anosphrasia in 1.Conclusion: Total resection of the medial sphenoid wing meningiomas depends on its position, degree of edema of surrounding tissues, size, texture, the relationship of the tumor to the ICA and Cavernous sinus.The use of CUSA and plasma knife can raise total removal rate of the tumor. Gamma knife radiosurgery for control of residual tumors and recurrent tumors is a safe and effective method.