gms | German Medical Science

Objective: To evaluate indications and technique of surgery in meningiomas with predominant intraorbital tumour growth.

Methods: The study presents a retrospective case series of 32 patients (28 females, 4 males; median age 48 years) who underwent 35 operations for meningiomas with predominant intraorbital tumour growth. All patients underwent tumour resection via a cranioorbital approach by an interdisciplinary team of a neurosurgeon and a maxillofacial surgeon. Microsurgical tumour removal via a combined osteoplastic cranio-orbital approach was performed in all cases. Bony reconstruction of the orbit using split-thickness calvarium bone graft was performed if necessary. All patients were closely followed by clinical examination and MRI and CT scans.

Results: Leading symptoms at presentation were progressive proptosis and deterioration of vision. Operative morbidity consisted predominantly of cranial nerve dysfunction which occurred in 22 patients. There were 5 postoperative infections, all were treated with antibiotics successfully. There was no operative mortality. In 20 patients preoperative visual function remained stable postoperatively. However, an improvement of visual function was observed in only 1 patient. Mean follow-up was 35 months. A tumour recurrence was observed in 3 patients, all underwent a second surgery. In these patients tumour was left behind in the sphenoid wing and cavernous sinus during first surgery. At last follow-up 8 patients presented with stable residual tumour and 24 patients demonstrated no evidence of tumour recurrence. The cosmetic result was judged to be very satisfying in 20 patients with complete resolution of proptosis whereas in the remaining patients the aesthetic condition was improved with some residuals.

Conclusions: Disfiguring proptosis and progressive loss of vision were considered to be indications for surgical resection of meningiomas with predominant intraorbital extension. For patients with preserved vision preoperatively a careful debulking of the tumour for decompression of the optic nerve and the orbit appears to be a valuable treatment option. However, in cases of incomplete tumour resection there is a significant risk of tumour recurrence. Microsurgical technique and a carefully designed surgical approach with bony reconstruction of the orbit are crucial to achieve a maximum tumour resection and a satisfying cosmetic result.