The greater wings of the sphenoid are the broad lateral expansions of the sphenoid bone forming the middle cranial fossa floor centrally and parts of the temporal fossa laterally. The superior orbital fissure between the greater and lesser wings transmits CN III, IV, VI, and V1. Foramen rotundum carries V2 (maxillary nerve) and foramen ovale transmits V3 (mandibular nerve) and the accessory meningeal artery. The foramen spinosum, most lateral, carries the middle meningeal artery.
The pterion, where the greater wing of the sphenoid meets the parietal, frontal, and temporal bones, is the thinnest point of the calvaria and lies directly over the anterior branch of the middle meningeal artery. A blow to the temporal region fractures through the pterion, lacerating the artery and producing an extradural haematoma. Sphenoid wing meningiomas arise from the greater wing and can invade the orbit producing proptosis, or encircle the carotid and middle cerebral arteries (en plaque variant). The foramina of the greater wing are important surgical landmarks during skull base approaches.
Temporal impact fractures the thin greater sphenoid wing at the pterion, lacerating the middle meningeal artery in its groove and producing a rapidly expanding extradural haematoma with the classic lucid interval followed by deteriorating consciousness; emergency evacuation via temporal craniotomy is life-saving.
Meningiomas of the sphenoid wing encircle or compress the middle cerebral artery, Sylvian fissure structures, and the orbit, producing progressive cognitive change, hemiparesis, and proptosis; surgical removal risks injury to encased vessels and is planned with meticulous vascular preservation technique.
