Spheno-orbital
meningioma (SOM) is an intriguing
tumor because of the many different factors that can influence clinical and oncological outcome
after treatment. Reasoning that outcome
indicator measurement is key to improving
therapy, we retrospectively evaluated the management of
proptosis and other ocular symptoms in 47 patients surgically treated for SOM at our department in the last 10 years. This patient series was characterized by a high rate of
tumor infiltration of the extradural cranial base. Clinical outcome was assessed by comparing preoperative and postoperative ophthalmological and neurological signs. Acute postoperative complications were reported, and clinical and radiological outcome was assessed at 4-6 months, 12 months, and the last follow-up.
Proptosis (measured by Hertel exophthalmometry), visual acuity, visual field defect (measured by Goldmann perimetry),
diplopia (measured by the Hess-Lancaster test), and other disturbances were rated as normalized, improved, or unchanged/worsened. The most common presenting symptoms were
proptosis (95.7%),
visual impairment (51%), and cranial nerve deficit (38.2%). Surgery via the frontotemporal approach was performed in all 47 cases, with the primary aim to relieve symptoms/signs and maximize
tumor resection. Bony orbital reconstruction was never performed. Complete resection was achieved in 51% of cases (Simpson grades I and II) with minimal morbidity. At a mean follow-up of 52 months (range, 12-112),
proptosis normalized in 90.9% and improved in the remaining patients, visual acuity normalized in 20.8% and improved in 45.8% patients, cranial nerve deficit subsided in all but two cases. The recurrence rate was 29.7%. One of the
gold standards of surgical treatment, normalization of
proptosis, can be achieved by accurate resection of the superior and lateral orbital walls. In this setting, careful reconstruction of the frontobasal dura is far superior to bony reconstruction. Complete
tumor resection should not be pursued at the expense of increased morbidity.