Resection of Sphenoorbital Meningiomas: Visual Outcomes from a Modern Cohort

Background The resection of spheno-orbital meningiomas (SOM) presents a unique challenge to skull base surgeons. Based on degree of brain, bone, and orbital invasion, outcomes can vary substantially between institutions. Of significant interest is the degree of visual impairment preoperatively and visual improvement postoperatively, as well as improvement in cosmetic deformity.

Methods A retrospective review was performed of patients with spheno-orbital meningiomas that were resected via a frontotemporal craniotomy between the years 2000 and 2017 at a single, large academic institution. Demographics, operative specifics, surgical outcomes, recurrence rates, and treatment strategies were statistically analyzed and compared, with a focus on exophthalmos and visual improvement

Results A total of 36 patients and 36 orbits were included in the analysis. Each of the 36 orbits was independently analyzed. Thirty-three patients had visual follow-up information available. Paired t-tests were used for statistical analysis. Of those that returned for follow-up, the mean number of follow-up days was 128.3 (range, 28–436 days). Snellen visual acuity was converted to logMAR (minimum angle of resolution) for data analysis. Mean preoperative visual acuity was 20/28 and mean postoperative visual acuity was 20/26 (p = 0.7). Mean preoperative exophthalmometry was 21.1 mm (range: 12–29 mm) and mean postoperative exophthalmometry was 17.3 mm (range: 10–25 mm; p < 0.01).

Conclusion Patients with spheno-orbital meningiomas often present with visual disturbance or significant cosmetic deformity. Our series found that surgical resection is a safe and effective treatment, with significant improvement in both measures.