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Lateral Transzygomatic Approach to Sphenoid Wing Meningiomas

Langevin, Claude-Jean DMD, MD1; Hanasono, Matthew M MD2; Riina, Howard A MD3; Stieg, Philip E PhD, MD3; Spinelli, Henry M MD2

doi: 10.1227/NEU.0b013e3181f8d3ad
Surgical Anatomy and Technique

BACKGROUND: Sphenoid wing meningiomas are slow-growing, well-circumscribed, and histologically benign lesions. The recurrence rate is low if removed completely at the time of surgery. Adequate surgical exposure with minimal morbidity is a challenge for those treating these lateral skull base lesions.

OBJECTIVE: To describe our experience with the lateral tranzygomatic approach for resection of sphenoid wing meningioms in which the entire zygoma is mobilized and remains vascularized by masseter muscle attachments.

METHODS: A retrospective review of the records of 19 patients who underwent sphenoid wing meningioma resection via a lateral transzygomatic approach between 1997 and 2007 was performed. A confirmatory cadaver dissection was performed to illustrate the anatomic nature of the technique. To achieve maximal exposure and minimal brain retraction, a lateral transzygomatic approach with osteotomies of the entire zygoma, which remains pedicled on the masseter muscle, was used.

RESULTS: Nineteen patients with sphenoid wing meningioma underwent resection via a lateral transzygomatic approach. Complete resection of the meningioma was achieved in 17 cases. Morbidity consisted of temporary frontal nerve weakness (57.9%), mild to moderate temporalis atrophy (36.8%), and diplopia (15.8%). There were no cases of wound infection, bone malunion, or resorption. A mean follow-up period of 33.1 months (range, 2-71 months) revealed no recurrences after surgery as demonstrated by computed tomography or magnetic resonance imaging.

CONCLUSION: The lateral transzygomatic approach to the sphenoid wing can be performed safely with minimal morbidity and facilitates complete resection of the tumor. Complete removal at an early stage is the best prognostic factor in treating sphenoid wing meningioma. This approach belongs in the armamentarium of surgeons who are involved in the resection of skull base neoplasms.

1Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio

2Division of Plastic Surgery, New York Presbyterian Hospital–Weill Cornell Medical Center, New York, New York; Current address: Department of Plastic Surgery, The University of Texas M D Anderson Cancer Center, Houston, Texas

3Division of Neurosurgery, New York Presbyterian Hospital–Weill Cornell Medical Center, New York, New York

Received, November 18, 2009.

Accepted, June 4, 2010.

Reprint requests: Henry M. Spinelli, MD, FACS, Weill Medical College of Cornell University, 875 Fifth Ave, New York, NY 10021. E-mail: hmspinelli@aol.com

Copyright © by the Congress of Neurological Surgeons