“Do everything possible—never at the cost of harm.”
"Surgery for a sphenoid wing meningioma is the art of removing disease while preserving what defines
“Surgery for a sphenoid wing meningioma is not merely the removal of a tumor, but a disciplined balance between precision and restraint—where the surgeon’s greatest skill lies in knowing how far to go, and how carefully to protect what makes the patient whole.”
Sphenoid Wing Meningioma
A sphenoid wing meningioma is a typically benign, slow-growing tumor that arises from the meninges along the sphenoid wing, a complex region of the skull base located in intimate proximity to the optic nerves and optic canal, the superior orbital fissure, the cavernous sinus, the pituitary region, and the internal carotid artery with its perforating branches. Because of this dense concentration of critical neurovascular structures, even relatively small tumors may produce significant symptoms, including progressive visual loss or visual field deficits, double vision from cranial nerve involvement, eye protrusion, headaches, seizures, or subtle cognitive changes. High-resolution MRI and CT imaging are essential to accurately define the tumor’s size, growth pattern, dural and bony involvement, vascular relationships, and the degree of optic nerve compression—factors that are fundamental to safe and effective surgical planning.
Treatment is highly individualized and depends on symptoms, documented tumor growth, anatomical extension, and the patient’s overall condition. Skull base microsurgery remains the primary treatment for symptomatic or enlarging sphenoid wing meningiomas, with the objective of achieving maximal safe resection while preserving vision, cranial nerve function, and normal cerebral blood flow. Dr. Bernardo employs advanced, highly precise skull base techniques designed to optimize exposure of the tumor–neurovascular interface while minimizing brain retraction. Central to this strategy are periclinoid maneuvers, including extradural and intradural anterior clinoidectomy when indicated, optic canal unroofing, and careful mobilization of the optic nerve and internal carotid artery. These steps allow early devascularization of the tumor, decompression of the optic nerve at its most vulnerable point, and a safer working corridor around the carotid–optic complex.
Meticulous microsurgical dissection is then carried out along natural arachnoid planes, with particular attention to preserving perforating vessels, cranial nerves within the cavernous sinus and superior orbital fissure, and normal dura. Tumor-involved bone and hyperostotic sphenoid wing are addressed thoughtfully to reduce recurrence while maintaining structural stability. These refined skull base and periclinoid techniques provide superior visualization of deep tumor extensions and permit controlled, progressive tumor removal with a reduced risk of visual or neurological injury.
In situations where complete resection cannot be safely achieved—most commonly due to firm adherence of the tumor to the optic nerve, internal carotid artery, or cavernous sinus contents—a planned subtotal resection followed by focused radiation therapy may be recommended to provide durable tumor control while prioritizing neurological preservation. In carefully selected patients with small, asymptomatic, or incidentally discovered sphenoid wing meningiomas, a strategy of close observation with serial imaging may also be appropriate.
