Comparison of the Surgical Outcome of Pterional and Frontotemporal-orbitozygomatic Approaches and Determination of Predictors of Recurrence for Sphenoid Wing Meningiomas.

Comparison of the Surgical Outcome of Pterional and Frontotemporal-orbitozygomatic Approaches and Determination of Predictors of Recurrence for Sphenoid Wing Meningiomas.

World Neurosurg. 2016 Oct 19;:

Authors: Bir SC, Maiti T, Konar S, Nanda A

Abstract
OBJECTIVE: The pterional/frontotemporal orbitozygomatic (FTOZ) approaches are the two widely used procedures for resection of sphenoid wing meningiomas. However, a comparison of outcomes and complications of these two approaches has not been well described yet. Here, we investigated the outcomes, complications and predictors of favorable outcomes of these two approaches.
METHODS: Data of ninety consecutive cases with sphenoid wing meningiomas between 1995 and 2015 was reviewed retrospectively. A Kaplan-Meier survival analysis and Cox proportional hazards regression model was used to determine the recurrence-free (RFS) survival and independent predictor of RFS.
RESULTS: In this study, the overall recurrence rate after tumor excision with pterional and FTOZ approaches was 36.5% and 12.2% respectively (p=0.001). Based on surgical approach, the median RFS of the patients with sphenoid wing meningiomas also varied significantly (pterional, 114 months vs. FTOZ, 145 months, p=0.03). The median RFS for patients with sphenoid wing meningiomas also varied according to the extent of resection (gross total resection, 146 months vs. sub-total resection, 52 months, p=0.009). In Cox regression analysis, FTOZ approach (p=0.041), gross total resection (p=0.047), and Karnofsky performance score (KPS) >70 (p=0.04) were revealed as significant predictors of favorable outcome after resection of sphenoid wing meningiomas.
CONCLUSIONS: In summary, sphenoid wing meningiomas undergoing extensive skull base approach (FTOZ) and gross total resection (GTR) had a low recurrence rate and higher RFS. Even though FTOZ with GTR is preferable to resect the sphenoid wing meningiomas, the procedure should be tailored to each patient depending on the risks and surgical morbidity.

PMID: 27771478 [PubMed - as supplied by publisher]

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