Sphenoorbital meningioma: a unique skull base tumor. Surgical technique and results

View More View Less
  • 1 Departments of Neurologic Surgery and
  • 2 Ophthalmology, Mayo Clinic, Rochester, Minnesota
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Sphenoorbital meningioma (SOM) is a unique skull base tumor, characterized by infiltrative involvement and hyperostosis primarily of the lesser wing of sphenoid bone, with frequent involvement of the orbital compartment. SOM often manifests with proptosis and visual impairment. Surgical technique and outcome are highly variable among studies reported in the literature. The authors present a single-surgeon experience with SOM.

METHODS

A retrospective review of a prospectively maintained institutional database was performed. A blinded imaging review by 2 study team members was completed to confirm SOM, after which chart review was carried out to capture demographics and outcomes. All statistical testing was completed using JMP Pro version 14.1.0, with significance defined as p < 0.05.

RESULTS

Forty-seven patients who underwent surgery between 2000 and 2017 were included. The median age at surgery was 47 years (range 36–70 years), 81% of patients were female, and the median follow-up was 43 months (range 0–175 months). All operations were performed via a frontotemporal craniotomy, orbitooptic osteotomy, and anterior clinoidectomy, with extensive resection of all involved bone and soft tissue. Preoperatively, proptosis was noted in 44 patients, 98% of whom improved. Twenty-eight patients (60%) had visual deficits before surgery, 21 (75%) of whom improved during follow-up. Visual field defect other than a central scotoma was the only prognostic factor for improvement in vision on multivariate analysis (p = 0.0062). Nine patients (19%) had recurrence or progression during follow-up.

CONCLUSIONS

SOM is a unique skull base tumor that needs careful planning to optimize outcome. Aggressive removal of involved bone and periorbita is crucial, and proptosis and visual field defect other than a central scotoma can improve after surgery.

ABBREVIATIONS CN = cranial nerve; CS = cavernous sinus; GKRS = Gamma Knife radiosurgery; GTR = gross-total resection; SOM = sphenoorbital meningioma; STR = subtotal resection.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Satoshi Kiyofuji: Mayo Clinic, Rochester, MN. skiyofu1@gmail.com.

INCLUDE WHEN CITING Published online August 23, 2019; DOI: 10.3171/2019.6.JNS191158.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Bikmaz K, Mrak R, Al-Mefty O: Management of bone-invasive, hyperostotic sphenoid wing meningiomas. J Neurosurg 107:905912, 2007

  • 2

    Castellano F, Guidetti B, Olivecrona H: Pterional meningiomas en plaque. J Neurosurg 9:188196, 1952

  • 3

    Cushing H: The meningiomas (dural endotheliomas): their source, and favoured seats of origin. Brain 45:282316, 1922

  • 4

    De Jesús O, Toledo MM: Surgical management of meningioma en plaque of the sphenoid ridge. Surg Neurol 55:265269, 2001

  • 5

    Dolenc V: Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg 58:824831, 1983

  • 6

    Froelich SC, Aziz KM, Levine NB, Theodosopoulos PV, van Loveren HR, Keller JT: Refinement of the extradural anterior clinoidectomy: surgical anatomy of the orbitotemporal periosteal fold. Neurosurgery 61 (5 Suppl 2):179186, 2007

    • Search Google Scholar
    • Export Citation
  • 7

    Honig S, Trantakis C, Frerich B, Sterker I, Schober R, Meixensberger J: Spheno-orbital meningiomas: outcome after microsurgical treatment: a clinical review of 30 cases. Neurol Res 32:314325, 2010

    • Search Google Scholar
    • Export Citation
  • 8

    Krayenbühl HA: Unilateral exophthalmos. Clin Neurosurg 14:4571, 1966

  • 9

    Li Y, Shi JT, An YZ, Zhang TM, Fu JD, Zhang JL, : Sphenoid wing meningioma en plaque: report of 37 cases. Chin Med J (Engl) 122:24232427, 2009

    • Search Google Scholar
    • Export Citation
  • 10

    Mariniello G, Maiuri F, Strianese D, Donzelli R, Iuliano A, Tranfa F, : Spheno-orbital meningiomas: surgical approaches and outcome according to the intraorbital tumor extent. Zentralbl Neurochir 69:175181, 2008

    • Search Google Scholar
    • Export Citation
  • 11

    Maroon JC, Kennerdell JS, Vidovich DV, Abla A, Sternau L: Recurrent spheno-orbital meningioma. J Neurosurg 80:202208, 1994

  • 12

    Mirone G, Chibbaro S, Schiabello L, Tola S, George B: En plaque sphenoid wing meningiomas: recurrence factors and surgical strategy in a series of 71 patients. Neurosurgery 65 (6 Suppl):100109, 2009

    • Search Google Scholar
    • Export Citation
  • 13

    Oya S, Sade B, Lee JH: Sphenoorbital meningioma: surgical technique and outcome. J Neurosurg 114:12411249, 2011

  • 14

    Pompili A, Derome PJ, Visot A, Guiot G: Hyperostosing meningiomas of the sphenoid ridge—clinical features, surgical therapy, and long-term observations: review of 49 cases. Surg Neurol 17:411416, 1982

    • Search Google Scholar
    • Export Citation
  • 15

    Ringel F, Cedzich C, Schramm J: Microsurgical technique and results of a series of 63 spheno-orbital meningiomas. Neurosurgery 60 (4 Suppl 2):214222, 2007

    • Search Google Scholar
    • Export Citation
  • 16

    Saeed P, van Furth WR, Tanck M, Freling N, van der Sprenkel JW, Stalpers LJ, : Surgical treatment of sphenoorbital meningiomas. Br J Ophthalmol 95:9961000, 2011

    • Search Google Scholar
    • Export Citation
  • 17

    Sandalcioglu IE, Gasser T, Mohr C, Stolke D, Wiedemayer H: Spheno-orbital meningiomas: interdisciplinary surgical approach, resectability and long-term results. J Craniomaxillofac Surg 33:260266, 2005

    • Search Google Scholar
    • Export Citation
  • 18

    Scarone P, Leclerq D, Héran F, Robert G: Long-term results with exophthalmos in a surgical series of 30 sphenoorbital meningiomas. Clinical article. J Neurosurg 111:10691077, 2009

    • Search Google Scholar
    • Export Citation
  • 19

    Schick U, Bleyen J, Bani A, Hassler W: Management of meningiomas en plaque of the sphenoid wing. J Neurosurg 104:208214, 2006

  • 20

    Shimizu S, Tanriover N, Rhoton AL Jr, Yoshioka N, Fujii K: MacCarty keyhole and inferior orbital fissure in orbitozygomatic craniotomy. Neurosurgery 57 (1 Suppl):152159, 2005

    • Search Google Scholar
    • Export Citation
  • 21

    Shrivastava RK, Sen C, Costantino PD, Della Rocca R: Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management. J Neurosurg 103:491497, 2005

    • Search Google Scholar
    • Export Citation
  • 22

    Terrier LM, Bernard F, Fournier HD, Morandi X, Velut S, Hénaux PL, : Spheno-orbital meningiomas surgery: multicenter management study for complex extensive tumors. World Neurosurg 112:e145e156, 2018

    • Search Google Scholar
    • Export Citation

Metrics