Sphenoid Wing Meningiomas

Sphenoid wing meningiomas represent approximately 4–9% of all intracranial meningiomas. Cushing and Eisenhardt classified the nodular meningiomas according to their site of origin as: inner third (anterior clinoid and spheno-cavernous), middle third (alar) and outer third (pterional). The clinical presentation is related to the site of origin and tumor volume. Lateral sphenoid wing meningiomas can present a nodular (en mass) or en plaque shape. The clinical presentation of sphenoid wing meningiomas is related to the site of origin and tumor volume. Medial sphenoid wing meningiomas can be associated with visual deterioration and visual field defects; alar and pterional (middle and lateral third sphenoid wing) meningiomas normally produce symptoms like seizures or hemiparesis only when they reach a large size. En plaque meningiomas are usually associated to an evolutive proptosis, caused by regional bone hyperostosis, presence of intraorbital tumor, periorbital tumoral infiltration or secondary to the venous stasis of the cavernous sinus. Upper eyelid swelling is another characteristic sign that can be present, as well as bone deformities due to temporal bone hyperostosis and/or temporal muscle infiltration. Visual impairment and diplopia are other common presenting symptoms. Surgical treatment using the fronto-temporal approach and its variants is considered the treatment of choice in symptomatic patients. Orbital reconstruction is suggested and can be accomplished using different techniques. Cavernous sinus or of the superior orbital fissure invasion are considered a contraindication to attempt radical removal; in such cases a multimodal treatment, including planned subtotal resection and radiosurgery can be considered.