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Video Abstract

Microsurgery for a medial left giant lesser sphenoid wing meningioma complicated by postoperative vasospasm of the ipsilateral supraclinoid carotid artery

Department of Neurology and Neurosurgery, Universidade Federal de São Paulo,
Hospital Beneficência Portuguesa de São Paulo, São Paulo – SP, Brazil.
Corresponding author: Feres Chaddad-Neto, Department of Neurology and Neurosurgery, Universidade Federal de São paulo, São Paulo – SP, Brazil.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Lessa SS, Chang Mulato JE, Dória-Netto HL, WuoSilva R, Filho JM, Chaddad-Neto F. Microsurgery for a medial left giant lesser sphenoid wing meningioma complicated by postoperative vasospasm of the ipsilateral supraclinoid carotid artery. Surg Neurol Int 2022;13:113.



Sphenoid wing meningiomas present close contact with intracranial arteries and have great potential for vascular complications. Here, we describe the case of a patient who presented a medial left giant lesser sphenoid wing meningioma involving the supraclinoid carotid artery. One week after surgery, she developed vasospasm whose treatment using milrinone achieved excellent results.

Case Description:

This is the case of a 23-year-old female with a large meningioma of the middle third of the lesser wing of the left sphenoid. Furthermore, the patient had symptoms of headache, diplopia, and left amaurosis (Video 1). The lesion involved the supraclinoid left carotid artery, causing significant stenosis of the vessel. The patient underwent surgical treatment without complications. One week after the procedure, she evolved with lowered level of consciousness, complete, and proportionate right hemiparesis and right Babinski’s sign. Angiographic study demonstrated significant stenosis of the left supraclinoid artery. After endovascular treatment with milrinone, the patient evolved with immediate improvement of signs and symptoms.

Video 1:

Video 1:Surgical procedure. Video is accessible from the portal.


Giant meningiomas with vascular involvement involve a higher risk of postoperative vascular complications. Other studies should be carried out to predict these complications and thus develop preventive measures.


Endovascular treatment
Giant sphenoid wing meningioma
Vascular encasement

[Video 1]-Available on:


  1. 0:13 – Clinical presentation

  2. 0:39 – Neurological examination

  3. 0:44 – Neuroimage findings

  4. 2:05 – Rationale for procedure

  5. 2:29 – Risks of the procedure and its potential benefits

  6. 3:12 – Alternatives and why they were not chosen

  7. 4:05 – Description of the setup

  8. 4:25 – Necessary equipment

  9. 4:36 – Key surgical steps

  10. 4:42 – Video

  11. 7:02 – Disease background

  12. 8:12 – A brief review of clinical and image outcome.


I would like to thank Prof. Feres Chaddad Neto for his constant support, motivation, and guidance during the execution of this work. He is not only my boss but also my mentor. In addition, I would like to thank the rest of the team for their effort and dedication. I would also like to thank the Federal University of São Paulo for opening the doors allowing me to be part of it.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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