الفهرس 
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Abstract
The aim of the present study was to evaluate to improve the management of patients with medial sphenoid wing meningiomas. A total of 16 patients diagnosed to have medial sphenoid wing meningioma presented to Neurosurgery department at Suez Canal University Hospital were subjected to surgical treatment using the pterional approach. Patients were assessed for intra and postoperative clinical outcome.
The study was conducted as a prospective cohort study aims at analysis of factors like protection of the sinus, avoidance of damages to the cerebral cortex, as well as other veins from the tumor by applying microsurgical techniques that might influence the clinical outcome of patients with medial sphenoid wing meningiomas that were surgically treated. All the operations were performed at Suez Canal University Hospital in the next two years by one team of the senior staffs of neurosurgery department.
A total of 16 patients with diagnosis of medial sphenoid wing meningiomas and were candidate for surgery were included in this prospective study after fulfilling inclusion and exclusion criteria.
Detailed history, complete clinical examination and radiological assessment (X-ray, CT and MRI) were done for all cases with MRV done for selected cases. All patients were operated using the pterional approach.
Mean age was estimated to be 46.8 years old with more than half of the studied patients in age group 45 – 54 years old. Majority of the studied patients were females (75%). Half of the patients were employee and 56.25% of them live in urban area.
The most commonly reported symptom among the studied patients was papilloedema (81.25%). Other common symptoms included headache (56.25%), convulsions (43.75%) and visual deterioration (43.75%). Less commonly patients were presented with symptoms of increased intracranial pressure (ICP) (37.5%), 3rd nerve palsy (25%), Foster-Kennedy syndrome (25%), proptosis (18.75%) and dysphasia (12.5%).
Neuro-imaging aided in identification of cavernous sinus invasion in three cases. Extension into the optic canal was evident in 2 cases and extension through the superior orbital fissure was evident in one case. Also imaging can classify these tumors into large ones > 3cm in diameter and small ones less than 3cm in diameter.
The fronto-temporal pterional approach was the surgical approach in all cases. Simpson grade I or II (gross total resection) was achieved in 13 patients (81.25%), and grade III or IV was attained in 3 cases (18.75%). A tumor¬al remnant (grade III or IV resection) was intentional-ly left in 3 patients. These 3 patients included two patients who had tumors that were adherent to the internal carotid artery ICA and middle cerebral artery (MCA), and one patient who had a tumor that was en-cased firmly in the optic nerve. No patients had intra-operative massive bleeding. Mean operative time was 110.5 minutes.
Visual deterioration was reported among (3/16) patients while there was visual improvement at 4 patients out of seven patients presented with visual deterioration. Early postoperative complications were reported only among 5 patients. Three of these five patients have postoperative hematoma while one patient had DVT and another patient have flap infection. All these complications were treated properly.
Reported mortality was one of operated 16 patients. This patient developed MCA territory infarction post operative immediately and died after 1 week. Other reported complications included Oculomotor palsy in 2 patients, brain edema in 3 patients and dysphasia/hemiparesis in 1 patient.
In conclusion, a conventional Pterional craniotomy was quite satisfactory in total removal of the 13 medial sphenoid wing meningiomas in this studied patients with greater success in small size masses (less than 3 cm), having no cavernous or orbital extension, rendering satisfactory outcome.