Surgical Treatment of Hyperostotic Sphenoorbital Meningiomas: Analysis of a Series of 388 Patients

Objectives: This article aims to analyze the results and outcomes of treatment for patients with hyperostotic sphenoorbital meningiomas.

Background: According to various reports, meningiomas with intraorbital extension account for 2 to 12% of all intracranial meningiomas. Among meningiomas of the skull base, these tumors represent 16 to 20%, while hyperostotic transformation of bone structures is observed in 40 to 78% of these patients. Currently, considering the successes in tumor growth control using radiation therapy, the clinician must find an optimal, “golden” balance: striving for radicality with minimal risks of intra- and postoperative complications, while preserving the patient’s quality of life at the highest possible level.

Material: The study was conducted prospectively. The study cohort comprised 388 patients with sphenoorbital meningiomas who underwent surgical treatment at the Burdenko Neurosurgery Center from 2017 to 2023. The female-to-male ratio varied depending on the age group, ranging from 5.7:1 to 3.5:1. The duration of the disease, defined as the difference between the date of onset and the date of the first surgical intervention during the study period, ranged from 1 to 432 months, with an average of 33.6 months. To create a topographic-anatomical classification, linear measurements of soft tissue and bone anatomical structures were performed on magnetic resonance and computed tomography scans of patients at various stages of treatment.

Results: Based on the location of the hyperostotically altered bone structures, the localization of intra- and extracranial soft tissue components of the tumor, and the ratio of the volumes of soft tissue components of different localization to each other and to the volume of hyperostosis, all meningiomas were divided into 4 groups, each of which contains 2 to 5 subgroups ([Fig. 1]). An analysis of the functional outcomes of treatment and a comprehensive assessment of the patients' quality of life after tumor removal were performed, depending on the tumor class, the extent of the pathological process, the surgical approach, the intraoperative techniques used, and the extent of bone structure reconstruction ([Fig. 2]). 17.9% of the study group patients underwent more than one operation.

The overall 5-year survival rate was 93.6%, and the 10-year survival rate was 91.0%. The median recurrence-free and progression-free survival in the study group was 113.1 months. The following statistically significant predictors of recurrence-free and progression-free survival after removal of hyperostotic meningiomas were found: classification group (p = 0.002); the radicality of tumor removal during the initial surgery (p = 0.003); histological type of the tumor (WHO grade; p < 0.001; [Fig. 3]).

Conclusion: Hyperostotic sphenoorbital meningiomas, in contrast to those without a hyperostotic component, constitute a distinct group of tumors characterized by notable specificity in clinical manifestations, radiological features, and surgical strategies. The proposed classification of sphenoorbital meningiomas considers the proportions, sizes, and localization of both soft tissue and hyperostotic components of the tumor. This allows for a tailored approach to selecting surgical treatment strategies, predicting the radicality of operations, determining the need for additional radiation therapy, assessing the likelihood of tumor recurrence, and evaluating both functional and cosmetic outcomes of the surgery.

Publication History

Article published online:
07 February 2025