Microsurgical Treatment of Spheno-Orbital Meningiomas: The Clinical Significance of the Tumor Invasion into the Greater Sphenoid Wing

Abstract

Objectives

The management of spheno-orbital meningiomas (SOM) is challenging due to complex characteristics of these tumors, such as extension into the orbit, hyperostosis of the greater sphenoid wing (GSW), and invasion of the superior orbital fissure (SOF), cavernous sinus (CS), and optic canal. To address this challenge, this study reports the results of microsurgically treated SOM patients and the nuances that affect the surgical technique.

Methods

The clinical data of 14 consecutive patients who underwent surgery through a microsurgical transcranial approach were collected retrospectively.

Results

Among 14 patients, exophthalmos was present in all patients, and facial numbness and visual acuity decline were both present in 50% of patients. Preoperative radiological imaging showed SOF narrowing in seven cases, optic canal compression in six cases, and CS invasion in five cases. Our surgical technique relies on direct removal of the affected GSW, promoting the removal of the temporal intradural tumor and decompression of the lateral wall of the orbit, optic canal, and SOF. Total removal of GSW is found to be beneficial in the treatment of SOMs since tumor invasion to the affected bone was observed in all cases. Simpson grade 1 resection was achieved in 64% of cases. CS invasion is present in five cases left intentionally unremoved. In two cases, a second surgery was required, while in four cases, radiotherapy was necessary.

Conclusion

Microsurgical treatment aiming for maximal safe resection with preservation of contents within the CS is the best option in the first-line treatment of SOMs. Aggressive removal of the bone tumor is beneficial in oncological control of the disease.

Keywords

greater sphenoid wing - meningioma - microsurgical treatment - orbita - sphenoid wing meningioma

Contributors' Statement

B.K. contributed to the conception and design of the study, data analysis, and study supervision. A.K. was responsible for data collection, data analysis, drafting the article, and revising the manuscript. R.C. and N.T. provided material support. A.M.K. contributed by critically revising the article, while G.Z.S. offered administrative support.

Publication History

Received: 13 June 2025

Accepted: 06 August 2025

Accepted Manuscript online:
08 August 2025

Article published online:
19 August 2025

• References

• 1 Agosti E, Zeppieri M, De Maria L. et al. Surgical treatment of spheno-orbital meningiomas: a systematic review and meta-analysis of surgical techniques and outcomes. J Clin Med 2023; 12 (18) 5840
• 2 Almeida JP, Omay SB, Shetty SR. et al. Transorbital endoscopic eyelid approach for resection of sphenoorbital meningiomas with predominant hyperostosis: report of 2 cases. J Neurosurg 2018; 128 (06) 1885-1895
• 3 Oya S, Sade B, Lee JH. Sphenoorbital meningioma: surgical technique and outcome. J Neurosurg 2011; 114 (05) 1241-1249
• 4 Dallan I, Castelnuovo P, Locatelli D. et al. Multiportal combined transorbital transnasal endoscopic approach for the management of selected skull base lesions: preliminary experience. World Neurosurg 2015; 84 (01) 97-107
• 5 Terrier LM, Bernard F, Fournier HD. et al. Spheno-orbital meningiomas surgery: multicenter management study for complex extensive tumors. World Neurosurg 2018; 112: e145-e156
• 6 Karımzada G, Evleksiz Karımzada D, Erol G. et al. Transorbital neuroendoscopic surgery for treatment of sphenoid wing meningiomas extending to the cavernous sinus: clinical implications and a technical illustration. Neurosurg Focus 2024; 56 (04) E8
• 7 Pieper DR, Al-Mefty O, Hanada Y, Buechner D. Hyperostosis associated with meningioma of the cranial base: secondary changes or tumor invasion. Neurosurgery 1999; 44 (04) 742-746 , discussion 746–747
• 8 Pompili A, Derome PJ, Visot A, Guiot G. Hyperostosing meningiomas of the sphenoid ridge–clinical features, surgical therapy, and long-term observations: review of 49 cases. Surg Neurol 1982; 17 (06) 411-416
• 9 Bikmaz K, Mrak R, Al-Mefty O. Management of bone-invasive, hyperostotic sphenoid wing meningiomas. J Neurosurg 2007; 107 (05) 905-912
• 10 Gonen L, Nov E, Shimony N, Shofty B, Margalit N. Sphenoorbital meningioma: surgical series and design of an intraoperative management algorithm. Neurosurg Rev 2018; 41 (01) 291-301
• 11 Roser F, Nakamura M, Jacobs C, Vorkapic P, Samii M. Sphenoid wing meningiomas with osseous involvement. Surg Neurol 2005; 64 (01) 37-43 , discussion 43
• 12 Saeed P, van Furth WR, Tanck M. et al. Natural history of spheno-orbital meningiomas. Acta Neurochir (Wien) 2011; 153 (02) 395-402
• 13 Bloss HG, Proescholdt MA, Mayer C, Schreyer AG, Brawanski A. Growth pattern analysis of sphenoid wing meningiomas. Acta Neurochir (Wien) 2010; 152 (01) 99-103 , discussion 103
• 14 Honig S, Trantakis C, Frerich B, Sterker I, Schober R, Meixensberger J. Spheno-orbital meningiomas: outcome after microsurgical treatment: a clinical review of 30 cases. Neurol Res 2010; 32 (03) 314-325
• 15 Mariniello G, de Divitiis O, Corvino S. et al. Recurrences of spheno-orbital meningiomas: risk factors and management. World Neurosurg 2022; 161: e514-e522
• 16 Fisher FL, Zamanipoor Najafabadi AH, Schoones JW, Genders SW, van Furth WR. Surgery as a safe and effective treatment option for spheno-orbital meningioma: a systematic review and meta-analysis of surgical techniques and outcomes. Acta Ophthalmol 2021; 99 (01) 26-36
• 17 Freeman JL, Davern MS, Oushy S. et al. Spheno-orbital meningiomas: a 16-year surgical experience. World Neurosurg 2017; 99: 369-380
• 18 Leroy HA, Leroy-Ciocanea CI, Baroncini M. et al. Internal and external spheno-orbital meningioma varieties: different outcomes and prognoses. Acta Neurochir (Wien) 2016; 158 (08) 1587-1596
• 19 Masalha W, Heiland DH, Steiert C. et al. Progression-free survival, prognostic factors, and surgical outcome of spheno-orbital meningiomas. Front Oncol 2021; 11: 672228
• 20 Shrivastava RK, Sen C, Costantino PD, Della Rocca R. Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management. J Neurosurg 2005; 103 (03) 491-497