Volumetric Analysis of Spheno-Orbital Meningiomas: Prognostic Correlation and a Compartmentalized Approach

Abstract

BACKGROUND AND OBJECTIVES: Spheno-orbital meningiomas arise from the arachnoid villi cap cells at the sphenoid ridge and have the ability to spread through soft tissue extension and cranial bone invasion. Owing to their orbital hyperostosis and intraorbital soft tissue extension, they commonly present with ophthalmologic manifestations. This study aims to investigate the correlation between tumor volume with the presenting symptoms and postoperative outcomes. METHODS: This retrospective study analyzed patients who underwent surgical resection of spheno-orbital meningiomas. Tumor volumes in different compartments were measured using preoperative and postoperative imaging. Linear and logistic regression analyses were used to identify correlations between tumor volumes and presenting symptoms preoperatively and postoperative outcomes. RESULTS: Sixty-six patients were included in this study, of whom 86.4% had proptosis, 80.3% had decreased visual acuity (VA), 30.3% had visual field defects, and 13.6% had periorbital edema. Preoperatively, proptosis linearly correlated with intraosseous tumor volume (coefficient = 0.6, P < .001), while the decrease in baseline VA correlated with the intraorbital tumor volume (coefficient = 0.3, P = .01). The odds of periorbital edema were found to increase with an increase in intraosseous tumor volume with an adjusted odds ratio of 1.4 (95% CI, 1.1-1.7, P = .003), while the odds of visual field defects were found to increase with an increase in intraorbital tumor volume with an adjusted odds ratio of 2.7 (95% CI, 1.3-5.6, P = .01). Postoperatively, the volume of intraosseous tumor resected linearly correlated with the improvement in proptosis (coefficient = 0.7, P < .001), while the volume of intraorbital tumor resected linearly correlated with improvement in VA (coefficient = 0.5, P < .001) and with a larger effect size in patients presenting with moderate-to-severe decrease in VA preoperatively (coefficient = 0.8). CONCLUSION: Underscoring the importance of each tumor compartment relative to the patient's symptomatology serves as a valuable guide in implementing a compartmentalized resection approach tailored to the surgical objectives.

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

“…Finally, the parenchymatous tumor can exhibit two patterns of growth: en-plaque (or flat), a thin carpet-like soft tissue growth at the dura mater, and globous (or round) with intradural growth. The hard consistency of the hyperostotic bone tissue of the lateral wall, as well as of the roof of the orbit, is the main cause for proptosis [ 5 , 18 , 19 ], which represents the main presenting symptoms of SOMs [ 5 , 9 , 10 , 14 , 18 , 19 , 20 ], and which usually is unilateral, non-pulsating, irreducible, and slow evolving. Despite some authors also hypothesizing periorbital tumor invasion, intraorbital tumor, and venous stasis from the compression of the ophthalmic vein as other causes of proptosis [ 21 ], the hyperostosis–proptosis correlation as a cause–effect is further supported by the significant correlation between intraosseous tumor volume resected and proptosis improvement, with success rates ranging from 50 to 100% [ 9 , 19 , 22 , 23 , 24 ].…”

“…The hard consistency of the hyperostotic bone tissue of the lateral wall, as well as of the roof of the orbit, is the main cause for proptosis [ 5 , 18 , 19 ], which represents the main presenting symptoms of SOMs [ 5 , 9 , 10 , 14 , 18 , 19 , 20 ], and which usually is unilateral, non-pulsating, irreducible, and slow evolving. Despite some authors also hypothesizing periorbital tumor invasion, intraorbital tumor, and venous stasis from the compression of the ophthalmic vein as other causes of proptosis [ 21 ], the hyperostosis–proptosis correlation as a cause–effect is further supported by the significant correlation between intraosseous tumor volume resected and proptosis improvement, with success rates ranging from 50 to 100% [ 9 , 19 , 22 , 23 , 24 ]. The involvement of the optic canal by hyperostosis, as well as by parenchymatous tumor invasion, accounts for the second most common presenting symptom of SOMs, i.e., visual acuity deficit [ 9 , 23 , 25 , 26 ].…”