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

Introduction: Spheno-orbital meningiomas (SOM) are intracranial tumours arising from the sphenoid wing. Common presentations include visual impairment, exophthalmos, and headache. Gross-total resection (GTR) is anatomically challenging. Subtotal resections (STR) present frequent residual progression. Adjuvant radiotherapy (aRT) is used for residual control but often causes radiation-induced neuropathies, necessitating individualized management strategies.

Methods: Between 2001 and 2023, we screened 100 patients who underwent SOM resection at our institution. They were separated into two groups: surgery-only (S-only) versus surgery followed by aRT (S-RT). We analyzed clinical presentation, surgical outcomes, resection rates, post-operative course, recurrence, and adjuvant therapy outcomes.

Results: 100 patients were included (68 S-only, 32 S-RT) with a median age of 58.5 years (range, 28 - 85 years). Mean follow-up was 66.1 months. Significantly more S-RT patients presented with exophthalmos (p=0.0095), optic neuropathy (p=0.0252), and retro-orbital pain (p=0.0166). S-RT lesions demonstrated more vascular encasement (p=0.0002), orbital involvement (p=0.0307), optic apparatus involvement (p=0.0187), and cavernous sinus invasion (p=0.0076). More GTR was achieved in S-only cohort (70.6%; p< 0.0001), with 16.2% (0% S-RT) Simpson grade I (p=0.0150) and 51.5% (18.8% S-RT) Simpson grade II (p=0.0022). Regrowth and recurrence rates did not significantly decrease following aRT.

Conclusion : Microsurgical management of SOM often results in subtotal resection of tumour 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 post-operative 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.