Spheno-Orbital Meningiomas Surgery: Multicenter Management Study for Complex Extensive Tumors

Area of Science:

• Neurosurgery
• Ophthalmology
• Oncology

Background:

• Spheno-orbital meningiomas (SOMs) are challenging tumors affecting the sphenoid wing and orbit.
• These tumors often cause bone hyperostosis and dural involvement, complicating surgical removal.
• Achieving optimal tumor resection, resolving proptosis, and preserving vision are significant clinical challenges.

Purpose of the Study:

• To evaluate the management strategies for surgically treated spheno-orbital meningiomas (SOMs).
• To analyze the relationship between surgical techniques and clinical outcomes in SOM patients.

Main Methods:

• Retrospective analysis of clinical records from 130 consecutive patients with SOMs over a 20-year period.
• Data collected included patient symptoms, surgical approaches, immediate post-operative outcomes, and long-term follow-up.
• Statistical analysis was performed to identify factors influencing clinical outcomes.

Main Results:

• The majority of patients (91.5%) were female, with a mean age of 51.2 years.
• Common symptoms included proptosis (94.6%), visual impairment (37.7%), and oculomotor paresis (10.0%).
• Simpson grade I-II resection was achieved in 74.6% of patients. Proptosis improved in 60% and visual acuity in 44.9% after one year. Periorbital excision correlated with reduced proptosis (P=0.0001), and optic canal decompression with visual stabilization (P=0.03). Bone reconstruction prevented temporal muscle atrophy and aesthetic deformities (P=0.01, P=0.0001). Mean follow-up was 76.5 months, with a mean recurrence time of 54.2 months.

Conclusions:

• Single-stage surgery incorporating bone reconstruction is the preferred first-line treatment for SOMs, individualized to each case.
• Optic canal decompression and periorbital excision are crucial for addressing visual disturbances and proptosis, respectively.
• Long-term surveillance is essential due to a notable rate of late recurrences.