Sphenoorbital meningioma: surgical series and design of an intraoperative management algorithm

Gonen, Lior; Nov, Eytan; Shimony, Nir; Shofty, Ben; Margalit, Nevo

doi:10.1007/s10143-017-0855-7

Cited by 47 publications

(43 citation statements)

References 33 publications

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“…SOMs are rare intracranial tumors, accounting for 2.3 to 11.8% of all intracranial meningiomas in literature. [1][2][3] Despite their benign histopathology, these tumors pose considerable surgical challenges mainly because of the difficulty to achieve radical resection. [3][4][5][6] However, the management philosophy has evolved over the years.…”

Section: Discussionmentioning

confidence: 99%

“…SOMs essentially differ from other sphenoid wing meningiomas in two characteristic radiological features-an intraosseous component and an orbital/periorbital component. 1,2,6,7,15 The bony involvement is characterized by hyperostosis of the sphenoid wing, both lesser and greater wings, orbital roof, SOF, OC, and the ACP. The orbital component can vary from a small intraorbital extension to extensive periorbital and intraconal extensions.…”

Section: Discussionmentioning

confidence: 99%

“…3,6,10,12,14 Two aspects of the surgical technique remain controversial: The first debate involves the removal of ACP as an integral routine step in surgery. Involvement of ACP is seen in 5 to 56% of the cases, [1][2][3]8,9,11,26 and hence few authors believe that anterior clinoidectomy and OC deroofing need be done only in affected patients. 2 We share the opposite view and believe that ACP removal and OC deroofing improves visual outcome and should be included as a routine step in surgery.…”

Section: Managementmentioning

confidence: 99%

“…Involvement of ACP is seen in 5 to 56% of the cases, [1][2][3]8,9,11,26 and hence few authors believe that anterior clinoidectomy and OC deroofing need be done only in affected patients. 2 We share the opposite view and believe that ACP removal and OC deroofing improves visual outcome and should be included as a routine step in surgery. 3,6,14,16,27 Selective rigid orbital reconstruction is another controversial surgical strategy.…”

Section: Managementmentioning

confidence: 99%

“…Spheno-orbital meningiomas (SOMs) that account for 4 to 9% of all intracranial meningiomas represent a complex subgroup of skull base tumors that characteristically present with proptosis and visual deficits. 1,2 SOMs are distinct from other types of sphenoid wing meningiomas in that the tumor characteristically has two components-a en plaque type of meningioma associated with hyperostosis involving the bone around the orbit and sphenoid wing. Published reports on the ophthalmological outcome following surgery for SOM are limited.…”

Section: Introductionmentioning

confidence: 99%

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Spheno-Orbital Meningiomas: Optimizing Visual Outcome

Menon

Onkarappa

Anand

et al. 2020

JNRP

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Background Spheno-orbital meningiomas (SOMs) constitute a rare cause for orbital proptosis and visual impairment. This study aims to share our outcome experience with regard to vision and exophthalmos following the surgical management of 17 patients with SOM. Methods Retrospective analysis of the case records of all surgically treated SOMs in the last 10 years. Exophthalmos index (EI) was calculated based on preoperative magnetic resonance imaging/computed tomography imaging. Vision was assessed using the Snellen’s chart and Goldman’s perimeter. Orbital volume was calculated using three-dimensional volume rendering assisted region-of-interest computation. Preoperative duration of symptoms and extent of surgery were the other predictors analyzed. Results Patients’ age ranged from 17 to 72 years (mean, 50.57 y; median, 50.0 years). Women represented 13 (76.4%) of the entire study group. Proptosis (14/17; 82.4%) and visual impairment (14/17; 82.3%) were the two most common presenting complaints followed by headache (12/17; 70.1%). Gross total resection (GTR) was achieved in only 2 of the 17 patients (11.8%). Majority of the tumors were benign World Health Organization Grade I meningiomas (14/17; 84%). Mean follow-up time for the entire cohort was 56 months. Postoperatively, proptosis improved in nine (64.3%) and remained static in the rest five (35.7%) of patients. Four patients (28.6%) improved in vision following surgery. Vision remained static in eight patients (57.1%). Vision deteriorated in two (14.3%) patients who had severe preoperative visual deficits. New onset oculomotor palsy, trigeminal dysfunction, and mechanical ocular motility restriction were noticed in three (17.6%), two (11.2%), and six (35.3%) patients, respectively. The mean preoperative orbital volume was 21.68 ± 3.2 cm3 and the mean postoperative orbital volume was 23.72 ± 3.4 cm3. Orbital volume was inversely related to EI. Optic canal (OC) deroofing and extensive orbital wall decompression facilitated visual improvement and proptosis reduction. None of the variables including orbital volume proved to be statistically significant in predicting outcome. Conclusion SOMs constitute a rare subgroup of skull base meningiomas that pose considerable surgical challenges. A surgical strategy aimed at safe maximal resection rather than aggressive GTR provides favorable outcome with less morbidity. Adequate bony decompression of the orbital walls and OC provides satisfactory improvements in proptosis and vision. Residual disease is common, but the risk of symptomatic recurrence is low especially when combined with adjuvant radiotherapy. Visual outcome is likely to be poor in patients presenting with severely compromised vision.

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