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

Abstract

Purpose: To describe a standardized orbital resection technique and outcomes for spheno-orbital meningiomas with soft-tissue invasion of the orbit. Methods: A retrospective case review of patients with spheno-orbital meningioma that underwent resection utilizing the Alberta Standardized Orbital Technique (ASOT) between 2008 and 2017 was performed. Results: Twenty patients met the inclusion criteria. Fifteen females and five males, with an average age of 53.4 years (SD ± 13.1 years). Mean follow-up was 57.3 months (SD ± 29.5 months). Eight cases (40%) had attempted resection prior to referral. Based on pre-operative plan, patients were divided into two groups based on goal of resection. Of those with planned complete resection (Group I), 11/13 patients (84.6%) underwent complete excision, with no cases of orbital recurrence. Incomplete resection in two cases occurred because of unexpected involvement of critical intra-cranial structures. Thus, in total 9/20 patients (Group II and 2 from Group I) underwent subtotal resection. Of these incomplete resections, five cases of orbital recurrence were observed; four patients required adjuvant external beam radiotherapy (EBRT) and one patient underwent further debulking surgery. Orbital control was achieved in three of these recurrent cases. Complications reported were persistent postoperative diplopia (three cases/15%) and wound infection (one case/5%). Overall, stable orbital disease was obtained in 18 patients (90%). Conclusion: The ASOT demonstrated to be effective, achieving the pre-operative plan of complete resection in 11/13 cases (84.6%) with no recurrence in those with clear orbital margins.

Anaplastic spheno-orbital meningioma: rapid growth after extensive exenteration

“…Radiographic studies to assess for recurrence should be considered postoperatively each 6 months for 2 years and yearly thereafter. 9 However, as was the case for our patient, CNS WHO grade 3 SOMs carry a poor prognosis for survival.…”

“…6 The primary treatment for anaplastic meningiomas is gross total surgical resection and adjuvant radiation. 9 The literature on chemotherapy is not yet conclusive. Resection of the orbital component of SOMs necessitates a multidisciplinary team including both neurosurgeons and orbital surgeons.…”

Spheno-Orbital Meningiomas

“…When considering only WHO grade I SOM, a Ki67 index ≥3.3 is associated with a higher risk of recurrence. Comparing these different histological subgroups, Agi et al reported a recurrence rate of 22% in the WHO grade I tumors and 50% in the WHO grade II tumors, with a mean follow-up of 57 months [46].…”