gms | German Medical Science

Objective: Bilateral intraosseous meningiomas of the sphenoid wing infiltrating both the orbits and the frontotemporal skull base with bilateral proptosis and visual impairment are extremely uncommon. Thus far, no treatment algorithms have been suggested for this entity. We report on the surgical management of three patients with bilateral hyperostotic sphenoorbital menigiomas.

Methods: All 3 patients underwent a pterional approach for surgical resection. Surgery was performed in two stages, primarily treating the most affected side. Treatment consisted of microsurgical resection of the infiltrated sphenoid wing and orbital walls, intraorbital tumor removal and optic nerve decompression. Orbital wall reconstruction was performed using titanium mesh allografts. Radiation therapy was administered in 1 patient with residual tumor infiltration of the cavernous sinus.

Results: Our series includes 2 women (51 and 68 years old) suffering from simultaneous progressive bilateral loss of vision and proptosis and 1 woman (69 years old), who developed contralateral disease after surgical resection of an intraosseous sphenoorbital meningioma 16 years earlier. After optic nerve decompression, vision improved in 2 cases after surgery. Initial visual deterioration was observed in 1 case but improved on long-term follow-up. The degree of proptosis was reduced in all treated eyes. There was no perioperative mortality.

Conclusions: In bilateral intraosseous sphenoorbital meningiomas, we propose staged surgery when clinical and radiological progression is observed. Although radical tumor resection is practically impossible in such extensive lesions, subtotal tumor resection with the aim of optic nerve decompression and subsequent orbital reconstruction provides satisfactory results. The most affected eye, which is not necessarily the eye with the most extensive tumor growth, should be treated first. In case of additional cavernous sinus infiltration, focal radiation therapy can be considered.