Abstract
Objectives
The management of spheno-orbital meningiomas (SOM) is challenging due to complex characteristics
of these tumors, such as extension into the orbit, hyperostosis of the greater sphenoid
wing (GSW), and invasion of the superior orbital fissure (SOF), cavernous sinus (CS),
and optic canal. To address this challenge, this study reports the results of microsurgically
treated SOM patients and the nuances that affect the surgical technique.
Methods
The clinical data of 14 consecutive patients who underwent surgery through a microsurgical
transcranial approach were collected retrospectively.
Results
Among 14 patients, exophthalmos was present in all patients, and facial numbness and
visual acuity decline were both present in 50% of patients. Preoperative radiological
imaging showed SOF narrowing in seven cases, optic canal compression in six cases,
and CS invasion in five cases. Our surgical technique relies on direct removal of
the affected GSW, promoting the removal of the temporal intradural tumor and decompression
of the lateral wall of the orbit, optic canal, and SOF. Total removal of GSW is found
to be beneficial in the treatment of SOMs since tumor invasion to the affected bone
was observed in all cases. Simpson grade 1 resection was achieved in 64% of cases.
CS invasion is present in five cases left intentionally unremoved. In two cases, a
second surgery was required, while in four cases, radiotherapy was necessary.
Conclusion
Microsurgical treatment aiming for maximal safe resection with preservation of contents
within the CS is the best option in the first-line treatment of SOMs. Aggressive removal
of the bone tumor is beneficial in oncological control of the disease.
Keywords
greater sphenoid wing - meningioma - microsurgical treatment - orbita - sphenoid wing
meningioma
