Superior orbital fissure narrowing and tumor-associated pain in spheno-orbital meningiomas

Zohdy, Youssef M.; Jahangiri, Arman; Alawieh, Ali; Agam, Matthew; Cosgrove, Megan; Jacob, Fadi; Porto, Edoardo; Argaw, Samson A.; Rodas, Alejandra; Maldonado, Justin; Chandler, Katherine E.; Barbero, J. Manuel Revuelta; De Andrade, Erion; Patel, Biren; Tariciotti, Leonardo; Vergara, Silivia; Pradilla, Gustavo; Garzon-Muvdi, Tomas

doi:10.1007/s00701-024-05979-2

Cited by 2 publications

(1 citation statement)

References 18 publications

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“…This purpose is not always achievable for SOMs due to their critical location of being close to highly functional neurovascular structures. Therefore, there is not unanimous consent regarding their management, which often varies among single institutions, with centers adopting the strategy of subtotal resection followed by radiation therapy or by “wait and see” and multiple re-operations over the years when symptoms occur [ 16 , 20 , 26 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Over the years, thanks to better knowledge being available on the natural history of this tumor and the refinements of the fields of surgery, radiation therapy, and technology, there has been a progressive “change in paradigm” of treatment, switching from the main goal of surgery of a gross total tumor resection to ensure the best functional outcome for the patient, with a special focus on preserving/restoring visual function and correct proptosis through orbital decompression while attempting to achieve maximum safe tumor resection with minimal postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Spheno-Orbital Meningiomas: The Rationale behind the Decision-Making Process of Treatment Strategy

Mariniello,

Corvino,

Corazzelli

et al. 2024

Cancers

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Surgery stands as the primary treatment for spheno-orbital meningiomas, following a symptoms-oriented approach. We discussed the decision-making process behind surgical strategies through a review of medical records from 80 patients who underwent surgical resection at the University of Naples Federico II. Different surgical approaches were employed based on the tumor’s location relative to the optic nerve’s long axis, categorized into lateral (type I), medial (type II), and diffuse (type III). We examined clinical, neuroradiological, surgical, pathological, and outcome factors. Proptosis emerged as the most frequent symptom (97%), followed by visual impairment (59%) and ocular motility issues (35%). Type I represented 20%, type II 43%, and type III 17%. Growth primarily affected the optic canal (74%), superior orbital fissure (65%), anterior clinoid (60%), and orbital apex (59%). The resection outcomes varied, with Simpson grades I and II achieved in all type I cases, 67.5% of type II, and 18% of type III. Recurrence rates were highest in type II (41.8%) and type III (59%). Improvement was notable in proptosis (68%) and visual function (51%, predominantly type I). Surgery for spheno-orbital meningiomas should be tailored to each patient, considering individual characteristics and tumor features to improve quality of life by addressing primary symptoms like proptosis and visual deficits.

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