Surgery as a safe and effective treatment option for spheno‐orbital meningioma: a systematic review and meta‐analysis of surgical techniques and outcomes

Abstract

Purpose The effectiveness and safety of surgery for spheno‐orbital meningiomas remains subject of debate, as studies often describe different surgical approaches and reconstruction techniques with very heterogeneous outcomes. We aimed to systematically summarize and analyse the literature on spheno‐orbital meningiomas regarding presenting symptoms, surgical techniques, outcomes and complications. Methods Studies were retrieved from eight databases. Original articles were included if in ≥5 patients presenting symptoms, surgical treatment and outcomes were described. Fixed‐ and random‐effects meta‐analysis was performed to estimate weighted percentages with 95%CIs of presenting symptoms, outcomes and complications. Results Thirty‐eight articles were included describing 1486 patients. Proptosis was the most common presenting symptom (84%; 95%CI 76–91%), followed by unilateral visual acuity deficits (46%; 95%CI 40–51%) and visual field deficits (31%; 95%CI 20–43%). In 35/38 studies (92%), a pterional craniotomy was used. Decompression of the optic canal (82%) and the superior orbital fissure (66%) was most often performed, and usually dural (47%) and bony defects (76%) were reconstructed. In almost all patients, visual acuity (91%; 95%CI 86–96%), visual fields (87%; 95%CI 70–99%) and proptosis (96%; 95%CI 90–100%) improved. Furthermore, surgery showed improvement in 96% (95%CI 78–100%) for both diplopia and ophthalmoplegia. The most common surgical complications were hypesthesia (19%; 95%CI 10–30%), ptosis and diplopia (both 17%; 95%CI, respectively, 10–26% and 5–33%) and ophthalmoplegia (16%; 95%CI 10–24). Conclusion Patients with spheno‐orbital meningioma usually present with proptosis or unilateral decreased visual acuity. Surgery shows to be effective in improving visual acuity and visual field deficits with mostly minor and well‐tolerated complications.

Spheno-orbital meningiomas: Is orbit reconstruction mandatory? Long-term outcomes and exophthalmos improvement

“…There are many approaches for this tumor. As discussed in a recent meta-analysis,[ 8 ] the most used surgical technique was the pterional craniotomy associated or not orbital wall, anterior clinoid, and optic canal removal. [ 2 , 18 ] Since 2008, orbitotomy through supraciliary or trans-eyelid approach started to be used.…”

“…In their meta-analysis, Fisher et al found a follow-up range between 3 and 135 months. [8] e same meta-analysis related improvement of 96% of the patients concerning diplopia and motility deficit after surgical resection, with hypesthesia of CNV as the most common postoperative complication. [8] is article aims to evaluate exophthalmos' improvement in a surgical series without orbital reconstruction and complications analysis.…”

“…[8] e same meta-analysis related improvement of 96% of the patients concerning diplopia and motility deficit after surgical resection, with hypesthesia of CNV as the most common postoperative complication. [8] is article aims to evaluate exophthalmos' improvement in a surgical series without orbital reconstruction and complications analysis. We discuss the preoperative presentation, surgical strategy, adjuvant treatment, and longterm outcomes.…”

“…found a follow-up range between 3 and 135 months. [ 8 ] The same meta-analysis related improvement of 96% of the patients concerning diplopia and motility deficit after surgical resection, with hypesthesia of CNV as the most common postoperative complication. [ 8 ]…”

Progression-Free Survival, Prognostic Factors, and Surgical Outcome of Spheno-Orbital Meningiomas

“…In our cohort, we observed a total of 10 patients with postoperative hypoesthesia in the region of the trigeminal nerve, which was significantly (p=0.0107) associated with GTR (Table 3). Other groups observed only sporadic trigeminal nerve deficits and other cranial nerve deficits (5,8,12,14,19,(24)(25)(26). This could be biased by the surgical experience of the surgeon and the aggression of the tumors.…”