Sphenoid Wing Meningioma In A SubSaharan African City
Abstract
BACKGROUND • Sphenoid wing meningiomas (SWMs) constitute about 14% to 20% of intracranial meningiomas. • In sub-saharan Africa, very late presentation is common with involvement of the cavernous sinus, internal carotid artery (ICA), and visual pathway. • Total excision is challenging, resulting in high morbidity and a high rate of re growth or recurrence. • Lagos University Teaching Hospital (LUTH) has 750 beds with Dedicated Neurosurgery wards • The population of Lagos is about 18 Million with 2 major academic hospitals, LUTH being the older • Patients are referred from within and outside the state
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PATIENTS AND METHODS
• Patients diagnosed with SWM in Lagos • Date February 2008 to December 2016 • Demography, Clinical, Radiological parameters and outcome data • Analysis done using SPSS ver 20 • Pearson chi square and Fisher’s exact test significance set at 0.05
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RESULTS
PATIENTS NUMBER %
MALE 9 26
FEMALE 26 74
TOTAL 35 100
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TREATMEN T
GENDER NUMBER %
SURGERY MALE 6 17
FEMALE 21 60
REFERRED ON REQUEST
BOTH 8 23
Clinical features (n =27) Frequency (%) Headaches 27 (100) Visual impairment 19 (70.4) Speech difficulties 14 (66.7) Seizures 23 (85.2) Hemiparesis 16 (59.2 Personality Changes 16 (76.2) Orbital Pain 13 (48.1) Poor Sleep 8 (29.6) Ptosis 8 (29.6)
• Diagnosis was by CT and/or MRI where available. Imaging was done prior to presentation in most patients. • > 70% has varying degree of calcifications • Encasement of the vessels was seen in >60%
• Age range 18yrs – 76yrs
• Mean age 52yrs
• Duration of symptoms: 3 – 8 years
• Tumour side: right – 10, left -17
PRE-OP AND POST OP (SIMPSON I)
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PRE-OP AND POST OP (SIMPSON II)
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Simpson grade of excision
Number (%)
Grade I 9 (33.3) Grade II 13 (48.1) Grade III & IV 2 (7.4)**
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• 3 perioperative mortality (not assessed) 11.1% • Simpson grade I & II – (81.5%) • 19 of the operated patients (70.4%) had complete resolution of symptoms Histology • Meningiothelial type 22/27 (85.7%) • Fibroblastic subtype 5/27 (14.3%)
Conclusion
• Late presentation of Sphenoid Wing Meningiomas is common in developing countries • Surgery still remains a principal treatment option for SWMs. • By applying good techniques for optimal surgical strategy, aiming for extensive resection, good disease control with minimal morbidity and good cosmetic and functional results can be achieved in the majority of cases. • Patients with medial type and incomplete resection should me followed up with MRI to recognize recurrence early • The threshold for brain imaging should drop further in patients presenting with CN impairments • STR with adjuvant RT can provide satisfactory results in cases where resection was not possible.