Surgical Treatment of Recurrent Spheno- Orbital Meningioma

Abstract

Objective: The extensive bone infiltration and carpet-like growth characteristics of spheno-orbital meningioma (SOM) make it hard to remove entirely, and recurrence and proptosis are the main reasons for reoperation. The authors report 20 cases of surgical treatment for recurrence of SOM, including surgical technique and symptom improvement. Methods: The clinical data and follow-up results of 20 cases of recurrent SOM at our institution from 2000 to 2017 were retrospectively analyzed. Results: All of the 20 patients with recurrence had received at least one operation before admission, with a mean age of 56 years and 70% female. The mean follow-up time was 36 months (172 months). All patients mainly showed symptoms such as proptosis and headache, and were found to be affected by supraorbital fissure during the operation. in 17 patients with recurrence, the affected sphenoid wing became tumor-like hyperplasia. Patients with extraocular muscle involvement have obvious protrusion and are often accompanied by diplopia. After surgical removal of the tumor, the symptoms of proptosis in 19 patients were significantly improved. During the follow-up, only 3 cases of proptosis recurred. After 15 patients underwent Simpson grade IV resection, 4 patients (27%) relapsed again. Five patients underwent Simpson III resection, and only 1 patient (20%) had tumor recurrence 18th months after surgery, and no proptosis recurred. Conclusions: The complete surgical removal of recurrent SOM is practically impossible. The main direction of surgical treatment should be to improve the symptoms of proptosis.

Surgical reconstruction for spheno‐orbital meningioma extending into the sphenoid sinus with hyperostosis

“…Orbital wall reconstruction after SOM surgery is crucial for restoring normal orbital volume and preventing ocular complications 12,19,20 . Several materials, such as bone grafts, 3,21 porous polyethylene, 22 titanium mesh, 23,24 and methylmethacrylate resin plates, 25 have been used for orbital bony reconstruction.…”

“…Orbital wall reconstruction after SOM surgery is crucial for restoring normal orbital volume and preventing ocular complications. 12,19,20 Several materials, such as bone grafts, 3,21 porous polyethylene, 22 titanium mesh, 23,24 and methylmethacrylate resin plates, 25 have been used for orbital bony reconstruction. Among them, titanium mesh is considered the most suitable option, as it can be manually shaped to fit the orbital walls and be attached to the orbital rim.…”

“…The management of SOMs presents a challenge for clinicians because of the tumor's potential involvement of critical structures, such as the nerves in the SOF or intraorbital muscles, as well as the high recurrence rates associated with incomplete resection. 11 , 12 , 13 Recent reports suggest that partial resection, in combination with postoperative radiation, may be a viable option in cases where radical resection is not feasible. 3 , 6 , 14 , 15 However, achieving aggressive resection of invasive tumors without causing neurological deficits remains a priority to reduce the likelihood of recurrence.…”