Sphenoid ridge meningiomas, two paradigms in 78 consecutive cases, lessons learned

Introduction SRM have been revisited with two different paradigms according to the technology we disposed: CT, DSA and MRI, DSA. The turning point was radiosurgery. Material and methods 78 cases operated on for a sphenoid ridge meningioma were identified. For all patients the clinical dates were retrospectively reviewed. Results The mean age was 49.8 years old (range 22-73 yrs.), 46 female and 32 male. The complains duration before surgery were at a mean 19.5 months (range 1-180 months). The most common complaint was headache (34 patients) followed by visual field or acuity disturbances (26 patients). Less common were seizures (16 patients), diplopia (5 patients), exophthalmia (4 patients). Dividing the sphenoid ridge in three portions, we identified 23 patients with the implantation of the meningioma in the external portion, 41 patients in the middle portion and 14 patients in the inner third. The approach mostly pterional one. We achieved in 42 patients a Simpson grade I removal, in 24 patients grade II and in 12 patients grade 3. Complications included transitory hemiparesis aggravation (1), from amblyopia to amaurosis (1), rhinorrhea (1), hydrocephalus which was shunted, pulmonary embolism (2) and ICA lacerations (2). Two recurrences reoperated. Discussion Operative nuances and lessons learned are discussed. The paradigm shift conditioned the decision of less aggressive when ICA CS is interested. Conclusion Sphenoid ridge meningiomas remain a challenge for the neurosurgeon. Good results can be achieved with microsurgery by experienced surgeons. Lessons learned in 78 cases shows that microsurgery remains the gold standard.