• Neurosurgery · Jun 2017

    Degree of Vascular Encasement in Sphenoid Wing Meningiomas Predicts Postoperative Ischemic Complications.

    • D Jay McCracken, Raymond A Higginbotham, Jason H Boulter, Yuan Liu, John A Wells, Sameer H Halani, Amit M Saindane, Nelson M Oyesiku, Daniel L Barrow, and Jeffrey J Olson.
    • Department of Neurosurgery, Emory University, Atlanta, Georgia.
    • Neurosurgery. 2017 Jun 1; 80 (6): 957-966.

    BackgroundSphenoid wing meningiomas (SWMs) can encase arteries of the circle of Willis, increasing their susceptibility to intraoperative vascular injury and severe ischemic complications.ObjectiveTo demonstrate the effect of circumferential vascular encasement in SWM on postoperative ischemia.MethodsA retrospective review of 75 patients surgically treated for SWM from 2009 to 2015 was undertaken to determine the degree of circumferential vascular encasement (0°-360°) as assessed by preoperative magnetic resonance imaging (MRI). A novel grading system describing "maximum" and "total" arterial encasement scores was created. Postoperative MRIs were reviewed for total ischemia volume measured on sequential diffusion-weighted images.ResultsOf the 75 patients, 89.3% had some degree of vascular involvement with a median maximum encasement score of 3.0 (2.0-3.0) in the internal carotid artery (ICA), M1, M2, and A1 segments; 76% of patients had some degree of ischemia with median infarct volume of 3.75 cm 3 (0.81-9.3 cm 3 ). Univariate analysis determined risk factors associated with larger infarction volume, which were encasement of the supraclinoid ICA ( P < .001), M1 segment ( P < .001), A1 segment ( P = .015), and diabetes ( P = .019). As the maximum encasement score increased from 1 to 5 in each of the significant arterial segments, so did mean and median infarction volume ( P < .001). Risk for devastating ischemic injury >62 cm 3 was found when the ICA, M1, and A1 vessels all had ≥360° involvement ( P = .001). Residual tumor was associated with smaller infarct volumes ( P = .022). As infarction volume increased, so did modified Rankin Score at discharge ( P = .025).ConclusionSubtotal resection should be considered in SWM with significant vascular encasement of proximal arteries to limit postoperative ischemic complications.Copyright © 2017 by the Congress of Neurological Surgeons

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