Spheno-orbital meningiomas: surgical techniques and results

Abstract

Introduction: Spheno-orbital meningiomas are characterized by bone invasion with extensive hyperostosis and possible encroachment into the orbit, infra-temporal fossa, and/or the cavernous sinus that render total surgical excision challenging. The surgical technique utilized is a key factor facilitating complete resection and hence improvement of proptosis and accompanying visual symptoms. Methods: This is a retrospective study of twenty-two patients (including 4 recurrent cases) with meningioma en-plaque, presenting with hyperostosis and proptosis. We describe the surgical approaches used, technique, and extent of resection in addition to postoperative outcome. Results: In twenty patients, the pterional approach was used, while two patients were operated on via the mini orbito-zygomatic approach. Total resection of the tumor was achieved in 10 cases (45.5%), subtotal in 6 (27.3%), partial in 5 (22.7%), and in 1 case, injury to the internal carotid artery lead to premature termination of surgery. Seventeen patients (77.3%) had improvement of proptosis, 2 (9.1%) had partial improvement, and 2 (9.1%) had no improvement at 3 months of follow-up. Post-operative morbidities include cerebrospinal fluid leak, infection, and hydrocephalus, each occurred in one (4.5%) different case. Conclusions: Proper drilling of the lateral and superior orbital walls with excision of any intra-orbital soft tissue components is all key points for better surgical resection and clinical regression of proptosis. However, factors such as extension of the hyperostosis to the infra-temporal fossa or medial orbital wall, tumor invasion of the cavernous sinus, or adherence of tumor to the orbital muscles, prevent total excision.