Spheno-Orbital Meningiomas

Abstract

Spheno-orbital meningiomas are mainly defined as primary en plaque tumors of the lesser and greater sphenoid wings, invading the underlying bone and adjacent anatomical structures. The patients, mostly women in their fifties, generally present with a progressive, unilateral, and nonpulsatile proptosis, often associated with cosmetic deformity and optic nerve damage. Surgical resection is currently the gold standard of treatment in case of optic neuropathy, significant symptoms, or radiological progression. The surgical strategy should take into account the morphology of the tumor, its epicenter at the level of the sphenoid wing, and the invasion of adjacent anatomical structures. Surgery stabilizes or improves visual function and oculomotricity in most cases but it is rare that the proptosis recovers completely. Gross total resection is hard to achieve considering the complex anatomy of the spheno-orbital region and the risk of inducing cranial nerve deficits. Rare cases of WHO grade II or III meningiomas warrant adjuvant radiotherapy. Tumor residues after subtotal resections of WHO grade I meningiomas are first radiologically monitored and then treated by stereotactic radiosurgery in case of progression.

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

“…Recently, Kong et al [ 13 ] provided an anatomical classification from a surgical endoscopic transorbital perspective based on the location of the tumor epicenter on the greater sphenoid wing, identifying three types by dividing that region into three thirds: medial, middle, and lateral. Later, Baucher et al [ 57 ], starting from the morphological classification by Roser et al [ 58 ] and the anatomical classification of Kong et al [ 13 ], added the parameter of tumor invasion of seven specific anatomical regions and structures: temporal fossa, infratemporal fossa, orbit, superior orbital fissure, anterior clinoid process, optic canal, and cavernous sinus. Therefore, when optic canal decompression is the main goal together with maximal safe tumor resection, a schematic approach to surgical strategy selection can be considered, focusing on the mantra that the pattern of the growth of the lesion around the optic canal drives the selection of the approach.…”