Medial Sphenoid Wing Meningiomas: Surgical Excision and Recurrence — A Comprehensive Review

Abstract

Medial sphenoid wing (MSW) meningiomas are challenging skull-base tumors because their dural attachment is closely related to the optic apparatus, supraclinoid internal carotid artery (ICA) and its branches, anterior clinoid process, cavernous sinus, superior orbital fissure, and cranial nerves. Although most meningiomas are histologically benign and slow growing, MSW tumors may produce substantial visual, neurological, and functional morbidity, and their surgical management requires a balance between extent of resection and preservation of critical neurovascular structures. This review summarizes the relevant anatomy, epidemiology, pathology, clinical presentation, radiological assessment, surgical principles, complications, recurrence, and established or emerging prognostic factors relevant to MSW meningioma. Particular emphasis is placed on tumor size, location, vascular and cavernous sinus involvement, optic canal invasion, tumor shape, extent of resection, WHO grade, proliferative and molecular markers, and postoperative management. Contemporary evidence supports a shift from indiscriminate radical resection toward maximal safe resection tailored to tumor biology and neurovascular relationships, with adjuvant radiotherapy or surveillance selected according to residual disease, grade, and recurrence risk.