Surgical Experience with Spheno-Orbital Meningiomas

Introduction: The spheno-orbital meningiomas are located in a functionally important region, often involving neurovascular structures. In some cases, the purpose of surgery is preservation and recovery of visual function. The aim of this study is to review the surgery strategies and outcome in these cases.

Material and Methods: We present a review from 1998 to 2007 of 52 patients (19 men, 33 women), ages from 29 of 78 years (mean age, 55.4). Thirty-eight patients presented with a disturbance of the optic nerve, 13 patients with limitation in the range of eye motion, and 4 patients with cosmetically disfiguring protrusio bulbi. Magnetic resonance imaging was part of the investigation and the surgical planning. Magnetic resonance angiography and CTA were facultative in cases with involvement of vascular structures. The patients were divided into 3 groups. The first group (11 patients) consisted of meningiomas with intraorbital growth, the second group (33 patients) of extraorbital tumors without invasion of the cavernous sinus, and the third group (8 patients) of meningiomas involving the cavernous sinus. In surgery of the spheno-orbital regions, various approaches can be used. The most common surgical approach used was the frontotemporal approach (79%); other approaches were fronto-orbital (4%) and frontotemporal-orbital (17%).

Results: The degree of resection was evaluated using the Simpson scale. In 29 cases, the resection was classified as Simpson 1/2, in 1 case as Simpson 3, and in 21 cases as Simpson 4. The remaining 1 patient only underwent a biopsy (Simpson 5). The most frequent histological grading was WHO I (48 cases), and the other 4 cases had a grade of WHO II. Postoperative follow-up ranged from 2 months to 6 years. Twenty-eight patients showed worsening of the neurological deficit. Twenty-five patients had residual or recurrent tumor.

Conclusion: Meningiomas of the spheno-orbital region are difficult to resect completely, particularly when there is involvement of vessels and nerves. Often only partial tumor removal is possible. Surgery of spheno-orbital meningiomas requires a multivector and interdisciplinary approach planning for each individual patient, analyzing the neurovascular structures in relation to the tumor.