Endoscopic endonasal approach for resection of a recurrent spheno-orbital meningioma resulting in complete resolution of visual symptoms: A case report and review of literature

J Neurooncol. 2022 Dec;160(3):545-553. doi: 10.1007/s11060-022-04141-1. Epub 2022 Nov 29.


Purpose: Spheno-orbital meningiomas are rare tumors, accounting for up to 9% of all intracranial meningiomas. Patients commonly present with proptosis, and visual deficits. These slow growing tumors are hard to resect due to extension into several anatomical compartments, resulting in recurrence rates as high as 35-50%. Although open surgical approaches have been historically used for resection, a handful of endoscopic approaches have been reported in recent years. We aimed to review the literature and describe a case of spheno-orbital meningioma with severe vision loss which was resected with an endoscopic endonasal approach achieving complete resolution of visual symptoms.

Methods: A systematic review of literature was conducted in accordance with the PRISMA guidelines. PubMed, Cochrane, and Web of Science databases were queried for spheno-orbital meningiomas resected via an endoscopic endonasal approach. Furthermore, the presentation, surgical management, and post-operative outcomes of a 53-year-old female with a recurrent spheno-orbital meningioma are described.

Results: The search yielded 26 articles, of which 8 were included, yielding 19 cases. Average age at presentation was 60.5 years (range: 44-82), and 68.4% of patients were female. More than half of the cases achieved subtotal resection. Common complications associated with endoscopic endonasal surgery included CN V2 or CN V2/V3 hypoesthesia. Following surgical intervention, visual acuity and visual field remained stable or improved in the majority of the patients.

Conclusion: Endoscopic approaches are slowly gaining momentum for treatment of spheno-orbital meningiomas. Further studies on the clinical benefits of this approach on patient outcomes and post-operative complications is warranted.

Keywords: Endonasal; Endoscopic approach; Neurosurgery; Optic tract; Spheno-orbital meningioma; Vision loss.

Publication types

  • Systematic Review
  • Case Reports
  • Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Male
  • Meningeal Neoplasms* / complications
  • Meningeal Neoplasms* / pathology
  • Meningeal Neoplasms* / surgery
  • Meningioma* / complications
  • Meningioma* / diagnostic imaging
  • Meningioma* / surgery
  • Middle Aged
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / surgery
  • Neurosurgical Procedures / methods
  • Orbital Neoplasms* / complications
  • Orbital Neoplasms* / surgery
  • Retrospective Studies
  • Sphenoid Bone / pathology
  • Sphenoid Bone / surgery
  • Treatment Outcome