← All decks
Neurosurgery
Surgical Management of Meningiomas of the Sphenoid Wing Re
Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology
What’s inside
11 sections · 65 slides
Overview
- What you will learn
Understanding the Tumor
What it is, where it grows, and how it behaves
- What is a meningioma of the sphenoid wing?
- Sphenoid wing meningiomas at a glance
- Where exactly they arise
- How a meningioma grows and why that helps the surgeon
- When the planes break down
The Four Subtypes
Location on the ridge changes everything
- Lateral sphenoid wing meningiomas
- Lateral sphenoid wing meningioma with Onyx embolization
- Medial sphenoid wing meningiomas
- Medial sphenoid wing meningioma on MRI
- Why medial tumors carry the most risk
- Spheno-orbital meningiomas
- Spheno-orbital meningioma and hyperostosis
- Cavernous sinus meningiomas
- Cavernous sinus meningioma on MRI
- The key to the cavernous sinus: its two-layered wall
- Layers of the cavernous sinus lateral wall
Who Needs Surgery
Indications and how each subtype presents
- When to operate
- How lateral vs. medial tumors present
- How spheno-orbital and cavernous sinus tumors present
Getting Ready to Operate
Imaging, angiography, embolization, and medical prep
- Two imaging tests, two different jobs
- Why angiography matters here
- Preoperative embolization: starving the tumor first
- Embolization of a sphenoid wing meningioma
- Protecting the carotid: balloon occlusion testing
- Medications and anesthesia before the incision
Setting Up the Operation
Goals, positioning, and initial exposure
- The surgeon's mental checklist
- Positioning on the table
- Positioning for a sphenoid wing craniotomy
- Draping and back-up plans
- Making the incision and freeing the muscle
- Head fixation, incision, and pterional burr holes
Opening the Skull
The craniotomy and the extended bony work
- The frontotemporal craniotomy and bone flap
- Craniotomy outline for sphenoid wing meningiomas
- When the standard flap is enough, and when it is not
- The Dolenc extradural bony takedown
- Drilling safely and controlling bone bleeding
Opening the Dura
Dural incision and splitting the sylvian fissure
- Opening the dura
- Splitting the sylvian fissure
Removing the Tumor
Devascularize, debulk, and dissect off critical structures
- Cut off the blood supply first
- Resecting lateral tumors
- Middle sphenoid wing meningioma resection
- Resecting medial tumors
- Medial sphenoid ridge meningioma, pre and post
- Protecting the optic nerve
- The cavernous sinus decision
- Finishing at the sphenoid ridge
Orbit and Closure
Decompressing the eye and rebuilding the barrier
- Decompressing the orbit and reversing proptosis
- Do you rebuild the orbital wall?
- Watertight closure
After Surgery
Recovery, surveillance, and adjuvant treatment
- Postoperative management
- Key takeaways (1 of 2)
- Key takeaways (2 of 2)
- Neurosurgical Operative Atlas: Neuro-Oncology