Spheno-orbital meningiomas: surgical techniques and results

Abstract

Introduction Spheno-orbital meningiomas are characterized by bone invasion with extensive hyperostosis and possible encroachment into the orbit, infra-temporal fossa, and/or the cavernous sinus that render total surgical excision challenging. The surgical technique utilized is a key factor facilitating complete resection and hence improvement of proptosis and accompanying visual symptoms. Methods This is a retrospective study of twenty-two patients (including 4 recurrent cases) with meningioma en-plaque, presenting with hyperostosis and proptosis. We describe the surgical approaches used, technique, and extent of resection in addition to postoperative outcome. Results In twenty patients, the pterional approach was used, while two patients were operated on via the mini orbito-zygomatic approach. Total resection of the tumor was achieved in 10 cases (45.5%), subtotal in 6 (27.3%), partial in 5 (22.7%), and in 1 case, injury to the internal carotid artery lead to premature termination of surgery. Seventeen patients (77.3%) had improvement of proptosis, 2 (9.1%) had partial improvement, and 2 (9.1%) had no improvement at 3 months of follow-up. Post-operative morbidities include cerebrospinal fluid leak, infection, and hydrocephalus, each occurred in one (4.5%) different case. Conclusions Proper drilling of the lateral and superior orbital walls with excision of any intra-orbital soft tissue components is all key points for better surgical resection and clinical regression of proptosis. However, factors such as extension of the hyperostosis to the infra-temporal fossa or medial orbital wall, tumor invasion of the cavernous sinus, or adherence of tumor to the orbital muscles, prevent total excision.

Correspondence of Meningioma Orbital Grading and Clinicopathological Features among Indonesian Patients

“…Spheno-orbital meningiomas are diagnosed based on their growth pattern and their radiographic appearance but not on their histological morphology. They tend to induce bone hyperostosis and the extent of hyperostosis is usually disproportionate to the size of the meningioma [27], [28]. In this study, there a recurrence of four subjects in Grade I meningioma and one subject in Grade III meningioma.…”

Endoscopic endonasal approach for resection of a recurrent spheno-orbital meningioma resulting in complete resolution of visual symptoms: A case report and review of literature

“…Open approaches provide a wider exposure to tumor tissue; however, they may be associated with functional and cosmetic post-operative complications, which can be avoided in minimally invasive techniques [ 12 , 15 ]. To date, there remains no consensus surrounding the reconstruction of orbital walls following tumor resection, with proponents of bony construction deeming it a necessity to reduce the occurrence pulsatile exophthalmos [ 16 ]. A recent meta-analysis found that the pterional approach relieves visual symptoms including diplopia, ophthalmoplegia, and visual acuity and field deficits in approximately 90% of patients [ 5 ].…”

Fronto-Temporo-Orbito-Zygomatic Approach with Orbital Reconstruction in Lesions causing Unilateral Non-pulsating Proptosis

“…3,[11][12][13][14] Frontolateral and FTOZ approaches are also recommended. 11,12,15 The latter is a modification of the classic pterional approach that increases surgical exposure to the orbit and decreases the need for brain retraction. 11 Based on our surgical experience and aiming at restoring the cosmetic and functional abilities of the patients, we preferred to use FTOZ in all patients.…”