Tag: Spheno-orbital meningioma

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Resectability of spheno-orbital meningiomas: surgical outcome in 93 cases and a proposed clinically relevant anatomical classification

J Neurosurg 144:336–345, 2026

This clinical study evaluates surgical outcomes for 93 patients with spheno-orbital meningiomas (SOMs) treated over two decades, proposing a four-grade anatomical classification based on orbital involvement. The paper reports presentation patterns, operative techniques, extent of resection, proptosis quantification with an exophthalmos index, and postoperative visual and surgical morbidity rates.

Using retrospective imaging and clinical data, the authors validate the grading system’s predictive value for resectability, proptosis improvement, and visual risk, showing higher gross-total resection rates in lower-grade tumors and substantial vision stabilization or improvement across grades. The work offers practical guidance for surgical planning and patient counseling in complex skull-base and orbital tumor management.

Anatomical Grading System: SOMs are classified into four grades based on orbital involvement: grade 1 (orbital hyperostosis), grade 2 (periorbital involvement), grade 3a/b (intraorbital involvement without/with rectus muscle invasion), and grade 4 (involvement of the orbital apex or optic nerve).

Surgical Resectability: Gross-total resection (GTR) is most achievable in grade 1 (88.5%) and decreases with higher grades (grade 2: 50.0%, grade 3: 16.7%, grade 4: 24.1%), primarily limited by critical neurovascular structures and functional vision considerations.

Presenting Symptoms: Proptosis (74.2%) and visual decline (57.0%) are the most common symptoms, with higher-grade tumors more likely to present with proptosis, vision loss, and cranial neuropathies.

Visual Outcomes: Surgery led to stable or improved vision in nearly 95% of patients across all grades, with no significant difference in visual morbidity between low- and high-grade tumors.

Proptosis Improvement: Correction of proptosis was most significant in grades 2 and 4, with overall exophthalmos index (EI) significantly decreasing after surgery; clinically significant enophthalmos was rare.

Surgical Morbidity: Overall morbidity increased with higher tumor grade but was not statistically significant; new ophthalmological cranial nerve neuropathies occurred in 11.8% of patients.

Surgical Approach: Aggressive removal of tumor and hyperostotic bone, with selective intraorbital dissection, optimizes functional outcomes and proptosis reduction; rigid orbital reconstruction is generally not required.

Clinical Utility: The grading system aids in predicting surgical risks, visual outcomes, and in guiding patient counseling and surgical planning for SOMs.

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Orbital reconstruction and volume in the correction of proptosis after resection of spheno-orbital meningiomas

J Neurosurg 140:1305–1311, 2024

The objective of this study was to evaluate the effect of reconstruction and orbital volume on the reduction of proptosis in patients undergoing resection for spheno-orbital meningiomas. Additionally, potential predictors of optimal proptosis reduction after surgery were evaluated.

METHODS Patients with spheno-orbital meningiomas who underwent resection at the authors’ institution between 2005 and 2020 were evaluated retrospectively. The exophthalmos index (EI) was measured on pre- and postoperative imaging to quantify proptosis and calculate the primary outcome measure of proptosis reduction. Patients were excluded if they had no preoperative proptosis (i.e., EI < 1.1), prior resection, or insufficient imaging available for analysis. Clinical and surgical characteristics were collected, including sex, extent of resection, WHO grade, and rigid orbital reconstruction, and assessed as predictors of greater proptosis reduction. Additionally, orbital volumes of the affected and contralateral orbits were measured to correlate postoperative orbital volumes with proptosis reduction.

RESULTS Thirty-three patients, with a mean age of 53 years, met inclusion criteria. The majority of the patients were female (23, 69.7%), and most tumors were classified as WHO grade 1 (29, 87.9%). Six patients (18.2%) underwent rigid orbital reconstruction. The mean EI across all patients decreased from 1.36 ± 0.18 to 1.19 ± 0.15 (p < 0.001). Patients who underwent reconstruction had on average a 76.4% greater reduction in the EI (p = 0.036) and a 9.1 times higher odds of achieving a normal EI (< 1.1) compared with those who did not receive reconstruction (OR 9.1, p = 0.025). Additionally, patients without residual hyperostotic bone compressing the orbit had a 2.16 times greater reduction in EI (p = 0.039). A linear relationship between orbital volume ratios (affected/unaffected orbit) and proptosis reduction was observed (p = 0.029, r = 0.529), including at ratios > 1.0. This suggests that greater orbital volumes postoperatively correlated with greater reductions in proptosis.

CONCLUSIONS Three factors were identified that optimize proptosis correction. First, all abnormal bone compressing the orbital contents must be removed completely. Second, rigid orbital reconstruction leads to improved proptosis correction, possibly by preventing frontal lobe and dural reconstruction from descending onto the compressed orbit. Third, aiming for an orbital volume slightly larger than the contralateral normal side leads to improved proptosis correction.

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Internal and external spheno-orbital meningioma varieties: different outcomes and prognoses

SO Meningiomas

Acta Neurochir (2016) 158:1587–1596

Internal variation among spheno-orbital meningiomas  (SOM) is surgically challenging. Optic canal invasion  management is discussed.

Method This retrospective study includes 70 patients with  SOM who underwent surgery between 1995 and 2012.  Preoperative ophthalmological, neurological and aesthetic  clinical signs were collected. All patients benefitted from repeated  tomography and magnetic resonance imaging (MRI).  The surgical team consisted of a neurosurgeon and a plastic  surgeon. In the majority of cases, resection was followed by  bone reconstruction using an autologous iliac crest graft. The  extent of resection was evaluated on the dural and osseous  sides. Early clinical outcomes, long-term follow-up, recurrence  and adjuvant therapies were reported.

Results The mean age was 52 years old, and 91 % of the  patients were women. Initial symptoms primarily included  proptosis (65 %), decreased visual acuity (39 %) and soft  tissue tumefaction (16 %).We classified 40 cases as the internal  variety when considering the inner third of the greater  wing of the sphenoid, optic canal, anterior clinoid process or  cavernous sinus. The remaining cases were described as the  external variety. The complete resection rates for the internal  and external varieties were 12 % and 61 %, respectively  (P< 0.001). In total, 90% of cases were grade I meningiomas.  For grade I, we reported 30 % recurrence, and 50 % of these  cases recurred in the first 2 years. Grade II cases without early  adjuvant radiotherapy increased at 2 years.We did not observe  any difference in recurrence rate among grade I tumours with  or without tumour remnants. At the end of follow-up, visual  acuity was stabilised or increased in 88 % of patients. In addition,  14 % of patients experienced persistent pain at the  location of the iliac harvesting site.

Conclusions The internal SOM variety exhibited a reduced  total resection rate and a shorter progression-free survival  (PFS). Unroofing of the optic canal extended PFS. Among  grade I cases, the persistence of a negligible tumour remnant  did not alter the probability of recurrence. For superior grades,  radiotherapy must be administered in addition to surgery as  soon as possible. SOMs require prolonged follow-up.  Autologous iliac reconstruction is related to substantial morbidity  and could be replaced by prosthetic bone threedimensional  reconstruction.

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