Sphenoid Wing Meningiomas: Single-Center Surgical Outcomes and Factors Associated with Resection Extent

Introduction: Sphenoid wing meningiomas (SWMs) often involve the optic canal or cavernous sinus, making resection difficult. We report a single-center series focusing on extent of resection (EOR) based on SWM characteristics. Methods: We conducted a single-center retrospective analysis from individuals with histologically diagnosed meningiomas at our institution from 2010 to 2024. Variables of interest included medial vs lateral wing, optic canal involvement, orbital involvement, cavernous sinus invasion, and middle cerebral or internal carotid artery encasement. EOR was derived from comparison of immediate post-operative MRI with pre-operative MRI. Chi-square and Fisher’s exact tests were used for comparisons. Results: 39 patients underwent surgical resection for a sphenoid wing meningioma. Median age was 62 [53 – 67] and 71.8% (28/39) were female. Gross total resection (GTR) was achieved in 56.4% (22/39) of patients, while subtotal resection (STR) or near total resection (NTR) was achieved in 43.6% (17/39) of patients. Medial wing tumors accounted for 38.5% (15/39) of cases. GTR was achieved in 79.2% (19/24) of lateral tumors compared to 20.0% (3/15) of medial tumors (p < 0.001). Patients were less likely to undergo GTR with cavernous sinus invasion (0% vs 64.7%, p < 0.001), carotid artery encasement (0% vs 41.2%, p = 0.001), optic canal invasion (27.3% vs 64.7%, p = 0.02), and orbital invasion (9.1% vs 58.8%, p = 0.001). Medial wing tumors were more likely to be associated with cavernous sinus invasion (60.0% vs 8.3%, p < 0.001), carotid artery encasement (40.0% vs 4.2%, p = 0.008), optic canal invasion (66.7% vs 29.2%, p = 0.02), and orbital invasion (53.3% vs 16.7%, p = 0.03). Conclusion: In our SWM series, extent of resection was limited by invasion or encasement of critical neurovascular structures. Medial sphenoid wing tumors were significantly more likely to involve the cavernous sinus, carotid artery, optic canal, and orbit, resulting in lower rates of GTR compared with lateral tumors. These findings highlight the importance for larger, multicenter studies to better define outcomes. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany