Anterior Clinoid line: A Predictor for Operative Outcome of Medial Sphenoid

Wing Meningiomas

Arab A. , Hawasai A.1, AlObaid A.2

King Abdulaziz Medical CityKing Fahad Medical City, Riyadh

Introduction• Meningiomas are benign tumors that are the most frequently diagnosed

primary brain tumors representing about 16-20% of intracranial tumors.

• Sphenoid wing meningioma accounts for approximately 20% of supratentorial lesions.

• Resection of this tumor is challenging and has a high mortality rate up to 32% and morbidity due to its proximity to vital structures including: the optic nerve, internal carotid artery and its branches, and cavernous sinus.

Objective

The purpose of this study is to establish an association between the

maximum diameter of the medial sphenoid wing meningioma (MSWM)

medial to the anterior cliondal line (AC line) and post-operative

complications.

Methodology• Study Design:

• A retrospective cohort study

• Sampling Technique:

• Convenience sampling of all surgically resected MSWM cases at the National Neurosciences

Institute at King Fahad medical City, Riyadh, Saudi Arabia over the last 10 years, who had pre-

operative MRI, and were followed up for at least three months.

• Data Collection

• Demographics, pre-operative signs and symptoms, post-operative complications and radiological

measurements were collected for all 35 cases that have fulfilled the inclusion criteria using

available medical records and radiological imaging.

AC Line MeasurementWe have measured the MSWM maximum medial

margin and maximum lateral margin in relation to a

line crossing the tip of the AC and parallel to a

midline that extends between the most caudal

edge of superior sagittal sinus and the most midline

structure, such as vomer or rostrum of the

sphenoid sinus.

AB

B

These measurements were then correlated

with patient demographics, preoperative

symptoms and post-operative assessment to

look for any significant correlations.

AC Line Measurement cont’d

A

Methodology cont’d

• The measurement of the maximum medial diameter of the MSWM ranged from 0 to 35, therefore, the median (13mm) was used to divide the cases into two groups.

• Group A: Medial extension of MSWM is <13mm

• Group B: Medial extension of MSWM is ≥13mm

Results

Demographics

Table 1.Clinical Features of Patients with Medial Sphenoid Wing Meningioma

Variable Number %

Number of cases 35 100

GenderFemale, noMale, no

279

75%25%

Median age, years 51 (Q25=40.5-Q75=70.0)

Diabetes, no 8 22%

Hypertension, no 9 25%

Out of 259 cases, 35 fulfilled the inclusion criteria

Medial Extension of MSWM and Extent of Resection

40%

60%

Group A

25%

75%

Group B

Total Resection

Subtotal Resection

Group A

0%

10%

20%

30%

40%

50%

60%

Pre-operative

Post-operative Worsening

Group B

0%

10%

20%

30%

40%

50%

60%

70%

80%

Pre-operative

Post-operative Worsening

Results cont’d

• In Group A, 10% developed ICH postoperatively, however, none of the

patients developed major complications including, CSF leak,

hydrocephalus, pneumocephalus, meningitis, or death.

• In Group B, meningitis was observed in 13% of the patients and

hydrocephalus in 7%.

Discussion

• This is the first description of AC line measurement and correlation with post operative complications.

• Goel et. Al. have created a grading system that depends on visual involvement, tumor size, and internal carotid involvement and correlates the total score with the extent of excision.

• Concluding that the extent of invasion has a direct effect on the extent of excision.

Conclusion• The percentage of gross total resection is higher in cases of MSWM

with medial extension less than 13mm, whereas the percentage of

subtotal resection is higher in cases with medial extension more than

13mm.

• The current study suggests that worsening of preoperative

neurological deficits can be correlated with increase in medial

extension of MSWM.

References1. Watts J, Box G, Galvin A, Brotchie P, Trost N, Sutherland T. Magnetic resonance imaging

of meningiomas: a pictorial review. Insights Imaging [Internet]. 2014 Feb [cited 2016 Jun 7];5(1):113–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24399610

2. Fonkem E, Dandashi JA, Stroberg E, Garrett D, Harris FS, El Nihum IM, et al. A retrospective analysis of meningioma in Central Texas. J Epidemiol Glob Health. 2016;6(2):87–93.

3. Lee JH, Sade B. Anterior Clinoidal Meningiomas. Meningiomas [Internet]. London: Springer London; 2009 [cited 2016 May 22]. p. 347–54. Available from: http://link.springer.com/10.1007/978-1-84628-784-8_36

4. Goel A, Gupta S, Desai K. New Grading System to Predict Resectability of Anterior Clinoid Meningiomas. Neurologia medico-chirurgica [Internet]. 2000;40(12):610–7. Available from: https://www.jstage.jst.go.jp/article/nmc/40/12/40_12_610/_pdf

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