Background: Despite significant advancements in the understanding of the skull base's anatomy and improvements in skull base and microsurgery, Medial Sphenoid Wing Meningiomas (MSWMs) remain a difficult condition for neurosurgeons to treat due to their unique anatomical location, the proximity of neurovascular structures, and the risk of cavernous sinus invasion. The objective of the research was to evaluate and contrast various treatment methods used for MSWMs and assess the effects of these methods on the clinical outcomes following surgery in patients with MSWMs.
Methods: The study involved 33 patients, comprising both male and female participants, each with a meningioma of varying sizes located in the medial sphenoid wing, across different age ranges. Three patient groups were established based on the treatment approach, consisting of patients undergoing surgery only, those receiving stereotactic radiosurgery only, and those undergoing both surgery and stereotactic radiosurgery. Results: Compared to group 2, papilledema was significantly higher in group 1 (P<0.05). A notable disparity was observed among three examined groups in terms of histopathology, with a probability of less than 0.05. Group 3 exhibited a significantly higher incidence of hyperostosis compared to group 2 (P<0.05). Vascular invasion was more pronounced in groups 2 and 3 compared to group 1, a difference that was statistically significant (P<0.05). The surgical approach and the extent of vascular resection also varied significantly among the three study groups (P<0.05). The postoperative complications, rate of recurrence, frequency of headaches, and occurrence of seizures showed no significant difference between the two groups. There were no instances of mortality in any of the three groups. Postoperative vision showed a notable improvement in groups 1 and 3 relatives to group 2, with a statistically significant difference (P<0.05). Conclusion: Key factors influencing the decision to operate on these tumors should be the patient's overall clinical condition and the tumor's radiological characteristics. Restrictive factors for radical removal include encasement of the internal carotid artery and its branches, along with their extension into the superior orbital fissure and the cavernous sinus.