Spheno-Orbital Meningiomas Surgery: Multicenter Management Study for Complex Extensive Tumors

World Neurosurg. 2018 Apr;112:e145-e156. doi: 10.1016/j.wneu.2017.12.182. Epub 2018 Jan 6.

Abstract

Background: Spheno-orbital meningiomas (SOMs) are complex tumors involving the sphenoid wing, the orbit, and sometimes the cavernous sinus with bone hyperostosis and sheet-like dural involvement. Optimal removal, proptosis cure, and visual preservation remain a challenge.

Objective: To study the management of surgically treated SOMs.

Methods: The clinical records of 130 consecutive patients undergoing surgery for SOMs were retrospectively collected in a database during a 20-year period to analyze symptoms, surgical technique, clinical outcome, and follow-up.

Results: Among the 130 patients (mean age 51.2 ± 9.5 years), 91.5% were female. The most typical symptoms recorded were proptosis in 94.6%, visual impairment in 37.7%, and oculomotor paresis in 10.0%. Simpson grade I-II removal was achieved in 97 patients (74.6%). After 1 year, proptosis was improved in 60% of cases. A total of 44.9% of the patients with preoperative visual acuity impairment were improved. Periorbital excision was statistically linked to proptosis decreasing (P = 0.0001) and optic canal decompression was linked to visual stabilization (P = 0.03). Bone reconstruction prevented temporal muscle atrophy (P = 0.01) and unaesthetic results (P = 0.0001). Mean follow-up was 76.5 months (range 3-288 months), and the mean time for recurrence was 54.2 months.

Conclusions: A single-stage optimal surgery with bone reconstruction appears to be the best first-line treatment, on a case-by-case analysis. Optic canal decompression and periorbital excision have to be performed in case of visual disturbance and proptosis. SOMs require a long-term follow-up because of a delayed high rate of recurrence.

Keywords: Proptosis; Skull base; Spheno-orbital meningioma.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Exophthalmos
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Meningeal Neoplasms / mortality
  • Meningeal Neoplasms / pathology
  • Meningeal Neoplasms / surgery*
  • Meningioma / mortality
  • Meningioma / pathology
  • Meningioma / surgery*
  • Middle Aged
  • Neurosurgical Procedures / methods*
  • Orbital Neoplasms / mortality
  • Orbital Neoplasms / pathology
  • Orbital Neoplasms / surgery
  • Proportional Hazards Models
  • Retrospective Studies
  • Treatment Outcome