Multidisciplinary Management of Spheno-Orbital Meningiomas

Background/Objectives: Spheno-orbital meningiomas (SOM) are rare entities with potentially significant impact on quality of life. In our unit these are managed in a multidisciplinary (MDT) service including neurosurgery and oculoplastic surgery which guides clinical assessment, radiological monitoring, management decision-making and surgical intervention.

Methods: Retrospective analysis of patients operated in a single center by the SOM multidisciplinary team. The cohort includes patients reviewed between 2006 and 2024. Demographics, pre- and posttreatment vision, tumor control and follow-up were recorded. Minimum follow-up of 6 months was required for inclusion.

Results: Overall 52 operations were recorded in 44 patients. Mean age at surgery was 49 with a large female preponderance. Eight patients had more than one operation. The indication for surgery was compressive optic neuropathy causing visual deterioration in 65% of patients, followed by scan progression in 25%. Proptosis was the sole indication in 4 patients, while almost all patients had a degree of proptosis at the time of the operation. Surgical resection in all cases involved maximal bony decompression of the visual pathway with lateral orbital wall decompression and anterior clinoidectomy. All involved dura and periorbita was excised except for tumor within the superior orbital fissure (SOF) and cavernous sinus. Orbital reconstruction was performed if >50% of the roof had been removed. All operations were performed by a joint surgical team of neurosurgeons and oculoplastic surgeons. Total or near-total resection was achieved in 71% of operations. Surgical complications included one intraoperative lateral rectus trauma, one CSF leak, two surgical site infections, and five patients with SOF dysfunction (only one of which was a persistent partial oculomotor palsy). Proptosis improved or resolved in 70% of patients. Histologically, four patients had WHO grade 2 tumors (2 of which were initially WHO grade 1; the remainders were all WHO grade 1. Overall, 24 radiotherapy treatments were offered (42% of the patients) with 23 as adjuvant and 1 as primary. Adjuvant treatment occurred at a mean of 2 years (range: 0–5) following surgery in the form of fractionated external beam radiotherapy. Mean follow-up was 207 months (6–640 months). Tumor stability on the latest scan was seen in 90% of patients. Vision had improved or remained stable in 89% of patients at their last examination.

Conclusion: Spheno-orbital meningiomas present a rare and challenging entity that mandate multidisciplinary working. Surgery should aim for maximal safe resection focusing on wide bony decompression, with adjuvant radiotherapy playing an important role in tumor control. Long-term vision preservation and tumor control rates are very good with multidisciplinary management and multimodality treatment.

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Artikel online veröffentlicht:
07. Februar 2025