Spheno-Orbital Meningioma: Surgical Outcomes and Management of Recurrence

• Published in: World neurosurgery 2019-06, Vol.126, p.e679-e687
• Main Authors: Nagahama, Atsufumi, Goto, Takeo, Nagm, Alhusain, Tanoue, Yuta, Watanabe, Yusuke, Arima, Hironori, Nakajo, Kosuke, Morisako, Hiroki, Uda, Takehiro, Ichinose, Tsutomu, Yamanaka, Kazuhiro, Ohata, Kenji
• Format: Article
• Language: English
• Subjects: Adult; Aged; Craniotomy; Female; Humans; Hyperostosis; Intraorbital extension; Male; Meningeal Neoplasms - surgery; Meningioma - surgery; Middle Aged; Neoplasm Recurrence, Local - surgery; Recurrence; Retrospective Studies; Skull Neoplasms - surgery; Spheno-orbital meningioma; Sphenoid Bone - surgery; Surgical strategy; Treatment Outcome; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.02.123

Spheno-orbital meningioma (SOM) is a rare intracranial tumor that arises at the sphenoid wing, extends into the orbit, and is associated with hyperostosis of the sphenoid bone. These tumors often invade important neurovascular structures around the orbital apex, superior orbital fissure, and cavernous sinus. Aggressive tumor removal could achieve acceptable control; however, residual tumor can regrow. In this article, our surgical management and long-term outcomes are described. Retrospectively, 12 patients with SOM who were treated surgically over a 21-year period were included. The clinical features and long-term tumor control were evaluated. Participants comprised 12 patients (5 men and 7 women). Mean follow-up was 74.4 months (range, 10–262 months). Ten patients (83%) were identified as World Health Organization grade 1 (WHO-I), and 2 patients (17%) were identified as WHO grade 2 (WHO-II). We encountered 4 recurrences, 2 of which needed additional surgeries. One patient with WHO-I (10%) experienced recurrence 10 years after the initial surgery and required a second surgery. Two patients with WHO-I (20%) showed slight regrowth of residual tumor around the superior orbital fissure; nevertheless, additive therapy was not recommended. Despite radical tumor resection, including eyeball and adjunctive radiotherapy for 1 patient with WHO-II, tumor recurrence in the posterior fossa was documented 19 years after the initial aggressive surgery. SOM follows a relatively benign clinical course given the invasive radiologic findings. Abnormal bone resection is paramount to prevent early-stage recurrence. Although intradural residual tumor might regrow, additional surgery could achieve reasonable long-term tumor control with better outcome.