Sphenoid wing meningioma en plaque: a clinical review.

OBJECTIVE: To review the role of craniofacial resection and reconstruction in the treatment of patients with sphenoid wing meningioma en plaque.

DESIGN: 15 patients were reviewed. The presenting features, operative details and complications were documented. The adequacy of resection was reviewed and postoperative scans were analyzed to assess orbital reconstruction. Patients were assessed regarding aesthetics and craniofacial function. The Glasgow outcome scale and the SF36 questionnaire were used to assess outcome.

RESULTS: The majority (92%) presented with proptosis and had disease extending from the sphenoid wing into the orbital roof (71%) and the middle fossa (71%). The transzygomatic approach was the most commonly used approach (85%). 14 patients were examined on an outpatient basis, one patient has died. In the majority of patients visual acuity was unchanged (85%) and in most cases (85%) there was significant improvement in globe position. Ptosis (57%) and upper eyelid swelling (50%) were a persistent problem. Craniofacial function and cosmesis were well maintained. Two patients have had clinical recurrences (14%). 14 have had a good outcome adjudged by the Glasgow outcome scale and most patients have satisfactory outcomes adjudged by the SF36 questionnaire.

CONCLUSIONS: Meningioma en plaque represents a difficult surgical challenge requiring a multidisciplinary approach. By using well established craniofacial techniques good disease control can be achieved with minimal morbidity and good functional and cosmetic results.