Natural History and Surgical Outcomes of Single-Center Experience in Management of Spheno-orbital Meningiomas

Background: Sphenoorbital meningiomas (SOM) are intracranial tumors that arise from the sphenoid wing. Common clinical presentations include visual impairment, exophthalmos, and headache. Radical resection is difficult due to anatomic complexity. Subtotal resections (STR) present high risks of residual progression. Adjuvant radiation therapy (RT) is used for establishing residual control. However, radiation-induced neuropathy and inflammatory responses often result, necessitating individualized management strategies.

Methods: Between 2001 and 2023, we screened 100 patients who underwent craniotomy and surgical resection for SOM at our institution, including 72 patients. They were separated into two groups based on postoperative management strategies: surgery-only (S-only) versus surgery followed by adjuvant RT (S-RT). We analyzed clinical presentation, surgical outcomes, resection rates, postoperative course, disease recurrence, and adjuvant treatment outcomes.

Results: A total of 72 patients (72.2% female) were included in our analysis (46 S-only and 26 S-RT) with a mean age of 59.1 years (range, 28–85 years). There were no major demographic differences between the two groups. Mean follow-up time was 70 months (66.5 months S-only vs. 73.6 months S-RT). The most common clinical presentations were visual acuity defect (47.2%), headache (43.1%), optic neuropathy (31.9%), and exophthalmos (26.4%). Greater extent of resection was achieved in S-only cohort (76.1% GTR vs. 15.4% GTR; p < 0.0001), with 23.9% (0% in S-RT) being Simpson grade I. Significantly more S-RT patients first presented with exophthalmos (42.3 vs. 17.4%; p = 0.0279) and retro-orbital pain (26.9 vs. 6.62%; p = 0.0295). S-RT lesions were more likely to demonstrate vascular encasement (57.7 vs. 28.3%; p = 0.0228), optic apparatus involvement (65.4 vs. 39.1%; p = 0.0491), and cavernous sinus invasion (50.0 vs. 23.9%; p = 0.0368). Tumor recurrence rate was 15.6% in S-only, 50% pre-RT (p = 0.037), and 33.3% post-RT. Residual progression rate did not significantly decrease with adjuvant RT (28.6% S-only vs. 15.4% post-RT, p > 0.9999); the mean time to progression was 41.3 months for S-only patients (vs. 83.6 months post-RT).

Conclusion: Microsurgical management of SOM often results in subtotal resection of tumor given the location of the lesion and critical neurovascular structures. We report outcomes after attempts at maximal safe resection and document patterns of recurrences. The postoperative course of SOM disease progression tends to be delayed around the areas of the orbit. Thus, long-term surveillance and individualized planning by a multidisciplinary skull base team is crucial in achieving proper management.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
07 February 2025