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

Abstract

Objective: The pterional/frontotemporal orbitozygomatic (FTOZ) approaches are the 2 most widely used procedures for resection of sphenoid wing meningiomas; however, a comparison of outcomes and complications of these 2 approaches has not been well described yet. Here, we investigated the outcomes, complications, and predictors of favorable outcomes of these 2 approaches.

Methods: Data of 90 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 [GTR], 146 months vs. subtotal resection, 52 months, P = 0.009). In Cox regression analysis, the FTOZ approach (P = 0.041), GTR (P = 0.047), and Karnofsky performance score >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 GTR had a low recurrence rate and greater 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.

Keywords: Craniotomy; Frontotemporal orbitozygomatic; Meningiomas; Pterional.