Challenging the osseous component of sphenoorbital meningiomas

Abstract

BackgroundIntraosseous growth is a unique feature of sphenoorbital meningiomas (SOM). Its close relation to neurovascular structures limits complete surgical resection and possibly contributes to the high recurrence rate.ObjectiveTo evaluate the growth behavior of intraosseous remnants and develop a protocol for precise intraoperative visualization of intraosseous SOM.MethodsWe included 31 patients operated for SOM from 2004 to 2017. The growth velocity of the intraosseous tumor component was volumetrically calculated in 20 cases. To improve accuracy of image guidance, we implemented a specialized bone surface-based registration algorithm. For intraoperative bone visualization, we included CT in multimodality continuous image guidance in 23 patients. The extent of resection (EOR) was compared with a standard MR-only navigation group (n = 8).ResultsIn 11/20 cases (55%), a progressive regrowth of the intraosseous SOM remnant was noted during a mean follow-up of 52 months (range 20–132 months). We observed a mean increase of 6.2 cm3 (range 0.2–23.7 cm3) per patient and side during the follow-up period. Bone surface-based registration was significantly more accurate than skin surface-based registration (mean 0.7 ± 0.4 mm and 1.9 ± 0.7 mm, p < 0.001). The EOR of the intraosseous component was significantly higher using CT + MRI navigation compared with controls (96% vs. 81%, p = 0.044).ConclusionQuantitative assessment of the biological behavior of intraosseous remnants revealed a continuous slow growth rate independent of the soft tumor component of more than half of SOM. According to our data, application of a multimodal image guidance provided high accuracy and significantly increased the resection rate of the intraosseous component of SOM.

Female gender and exogenous progesterone exposition as risk factors for spheno-orbital meningiomas

“…Two teams published their series twice in this period 6,[17][18][19] , and we excluded the smaller one in each case. Thus, we identified 14 articles each reporting 13 to 130 patients, as detailed in table 2 6,18,[20][21][22][23][24][25][26][27][28][29][30][31] .…”

The Alberta standardized orbital technique in the management of spheno-orbital meningiomas

“…3 Progressive enlargement is followed by compression of surrounding structures, such as the orbit, superior orbital fissure, optic canal, and cavernous sinus, which may lead to visual deterioration, disturbance of ocular motility, proptosis, and cosmetic disfigurement. [9][10][11] Compared with other meningiomas, SWMs possess higher mortality, disability rate, and recurrence rates. 12 Although, some argue that cure is not achievable for sphenoid wing meningiomas, a cure would be obtainable if complete surgical resection could be achieved as is seen in other more surgically amenable locations.…”

Spheno-Orbital Meningiomas: Optimizing Visual Outcome

“…18 This indicates that hyperostosis essentially is a part of the neoplastic process and GTR implies removal of the entire affected bone, which is a formidable surgical challenge. 1,29,30 Signal intensity changes in SOMs on MRI are similar to other meningiomas. SOMs, however, tend to breach the pia of the brain parenchyma, and the tumor brain interface is often not distinct on MR images.…”