Predictors of Visual Outcome Following Surgical Resection of Medial Sphenoid Wing Meningiomas

Objective: Medial sphenoid wing meningiomas (SWMs) are relatively common tumors that are associated with significant morbidity and mortality, primarily from their anatomic proximity to many critical neurological and vascular structures. A major complication is visual deterioration. This study aimed to identify predictors of visual outcome following medial SWM resection.

Methods: All patients who underwent medial SWM resection at the Johns Hopkins Hospital between 1998 and 2009 were retrospectively reviewed. Predictors of postoperative visual decline were assessed by stepwise multivariate proportional hazards regression analysis. Visual function was gauged by ophthalmologic examination preoperatively and at the last follow-up visit by an independent neuro-ophthalmologist.

Results: Sixty-five medial SWM resections were performed. After multivariate proportional hazards regression analysis, preoperative visual decline [RR(95% CI); 13.431 (2.601-46.077), P = 0.006], subtotal resection [RR (95% CI); 3.717 (1.204-13.889), P = 0.02], and repeat surgery [RR (95% CI); 5.681 (1.278-19.802), P = 0.03] were found to be independent predictors of visual decline at last follow-up. Tumor recurrence and postoperative radiation therapy trended toward, but did not reach statistical significance.

Conclusion: These findings advocate for early and aggressive surgical intervention for patients with medial SWMs to maximize the likelihood of subsequent visual preservation. This may provide patients and physicians with prognostic information that may guide medical and surgical therapy for patients with medial SWMs.