MICROSURGICAL TECHNIQUE AND RESULTS OF A SERIES OF 63 SPHENO-ORBITAL MENINGIOMAS

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OBJECTIVE: For this study, spheno-orbital meningiomas (SOMs) are defined as intraosseus meningiomas at the base of the anterior and middle cranial fossa, involving the sphenoid wing and orbit associated with a carpet-like, soft tissue component. We describe a surgical series of 63 SOMs, including surgical technique, complications, and recurrences. METHODS: For this retrospective series, patient charts of those who underwent operation for SOM by or under the supervision of the senior author (JS) at two institutions were identified and reviewed. Follow-up data was collected for up to 17 years (median, 4.5 yr). RESULTS: Between 1983 and 2003, 63 patients with a mean age of 51 years underwent operation for SOM. The most common preoperative sign was proptosis (79%), followed by visual acuity deficits (27%). Preoperative symptoms included a visual acuity below 0.8 (47%) and visual field deficits of 32%. Bony resection included the lesser sphenoid wing, the lateral orbital wall, the orbital roof, the optic canal, and the middle fossa base. Periorbital tumor infiltration led to intraorbital resection in 32 cases, and five cases presented a solid intraorbital tumor. After surgery, proptosis improved in 77% of the patients; 64% of the patients had improved visual acuity, and 58% of the patients with preoperative deficits had improved visual fields. Postoperatively, 12 patients showed temporary oculomotor deficits, and eight patients showed permanent oculomotor deficits. Temporary (n = 9) and persisting (n = 2) ptosis was observed. The median follow-up period was 4.5 years. Seventy-six percent of patients had tumor residuals, of which 61% were stable and 39% were progressive. Eleven tumor residuals were operated and four were treated by radiation. CONCLUSION: Complete surgical resection of SOMs is frequently impossible because the involvement of delicate structures of the orbital cone is common. Although some persisting neurological deficits are possible, proptosis and other visual deficits are often relieved. Two-thirds of tumor rests remained stable during the follow-up period. Consequently, the surgical aim should be the relief of leading symptoms rather than radical resection.

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