gms | German Medical Science

Objective: Surgical management of spheno-orbital meningiomas ranges among the most complex of intracranial tumors. Involving the sphenoid wing, the orbit and presenting mostly with proptosis or visual function deterioration, complete resection is of utmost importance, but may turn out very difficult.

Method: In a retrospective study, 16 patients (aged 35.4–67.5, mean 51±10.9 years, 15 women) operated on for spheno-orbital meningiomas between 2002 and 2011 were identified. Clinical signs, radiological and intraoperative findings, surgical approach and complications, management of reconstruction of the orbit and postoperative as well as follow-up results were evaluated.

Results: Main symptom was proptosis (87.5%), followed by diminished visual acuity (18.8%) and vertigo (12.5%). In 12 patients (75%) the lateral orbit was resected, whereas two patients experienced an orbitozygomatic approach (12.5%). Removal of the orbital roof was necessary in three patients (18.8%). For reconstruction of the orbit split calvarian bone and titanium mesh were used each in six patients (37.5%); in one patient both techniques were applied. In four patients (25%), no reconstruction was necessary. Total microscopic tumor resection (Simpson Grade 1 and 2) was achieved in 12 patients (75%). Postoperatively, proptosis improved in 92.9%; visual acuity showed stable or improved in all affected patients. Oculomotor deficit was temporary and persisting each in one patient. Median follow-up was 3.5±2.6 years. Tumor residual was present in six patients, of which three progressed. One patient underwent reoperation, and gamma knife surgery followed by radiotherapy was applied in another patient. In the third patient, tumor growth was little; observation was best option.

Conclusions: Despite their delicate anatomical relations spheno-orbital meningiomas mostly can be resected totally, with good clinical and radiological results. However, in order to avoid impending neurological deficits, subtotal or partial resection of spheno-orbital meningiomas followed by radiation therapy may be necessary in few cases.