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

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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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Intraoperative microscopic view in a case of right SOM. The dural incision around the tumor (T) is extended to the falciform ligament (FL) to decompress the optic nerve (ON). Figure is available in color online only.

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    A: Gadolinium-enhanced axial T1-weighted MR image of the brain obtained preoperatively, showing a mass with peripheral dominant enhancement in the lesser wing of the sphenoid bone on the left side. The tumor size is demonstrated, from the anterior margin to the posterior margin of the tumor. B: CT scan revealing significant hyperostosis of the tumor. C: Postoperative CT scan demonstrating satisfactory resection of the hyperostotic tumor. The defect was reconstructed with titanium mesh. Figure is available in color online only.

  • View in gallery

    Imaging studies of SOM and other meningiomas involving the sphenoid bone. A: Gadolinium-enhanced T1-weighted MR image of the SOM, demonstrating the main focus of the tumor being evident in the right lesser wing of the sphenoid bone. There is also an intradural and intraorbital component of the tumor, compressing the right optic nerve. Proptosis is also noted. B: CT in bone window of the SOM, revealing abnormal thickening of the lesser wing of the sphenoid bone. C: Example of a lateral sphenoid wing meningioma on the right side. The main component of the tumor exists intradurally, and hypertrophy of the lesser wing of the sphenoid bone is not significant. D: Example of a medial sphenoid wing meningioma on the left side. The tumor is located near the lesser wing of the sphenoid bone; however, this is an intradural tumor without an intraosseous component.

References

  • 1

    Bikmaz KMrak RAl-Mefty O: Management of bone-invasive, hyperostotic sphenoid wing meningiomas. J Neurosurg 107:9059122007

  • 2

    Castellano FGuidetti BOlivecrona H: Pterional meningiomas en plaque. J Neurosurg 9:1881961952

  • 3

    Cushing H: The meningiomas (dural endotheliomas): their source, and favoured seats of origin. Brain 45:2823161922

  • 4

    De Jesús OToledo MM: Surgical management of meningioma en plaque of the sphenoid ridge. Surg Neurol 55:2652692001

  • 5

    Dolenc V: Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg 58:8248311983

  • 6

    Froelich SCAziz KMLevine NBTheodosopoulos PVvan Loveren HRKeller JT: Refinement of the extradural anterior clinoidectomy: surgical anatomy of the orbitotemporal periosteal fold. Neurosurgery 61 (5 Suppl 2):1791862007

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Honig STrantakis CFrerich BSterker ISchober RMeixensberger J: Spheno-orbital meningiomas: outcome after microsurgical treatment: a clinical review of 30 cases. Neurol Res 32:3143252010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Krayenbühl HA: Unilateral exophthalmos. Clin Neurosurg 14:45711966

  • 9

    Li YShi JTAn YZZhang TMFu JDZhang JL: Sphenoid wing meningioma en plaque: report of 37 cases. Chin Med J (Engl) 122:242324272009

  • 10

    Mariniello GMaiuri FStrianese DDonzelli RIuliano ATranfa F: Spheno-orbital meningiomas: surgical approaches and outcome according to the intraorbital tumor extent. Zentralbl Neurochir 69:1751812008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Maroon JCKennerdell JSVidovich DVAbla ASternau L: Recurrent spheno-orbital meningioma. J Neurosurg 80:2022081994

  • 12

    Mirone GChibbaro SSchiabello LTola SGeorge B: En plaque sphenoid wing meningiomas: recurrence factors and surgical strategy in a series of 71 patients. Neurosurgery 65 (6 Suppl):1001092009

    • Search Google Scholar
    • Export Citation
  • 13

    Oya SSade BLee JH: Sphenoorbital meningioma: surgical technique and outcome. J Neurosurg 114:124112492011

  • 14

    Pompili ADerome PJVisot AGuiot G: Hyperostosing meningiomas of the sphenoid ridge—clinical features, surgical therapy, and long-term observations: review of 49 cases. Surg Neurol 17:4114161982

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Ringel FCedzich CSchramm J: Microsurgical technique and results of a series of 63 spheno-orbital meningiomas. Neurosurgery 60 (4 Suppl 2):2142222007

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Saeed Pvan Furth WRTanck MFreling Nvan der Sprenkel JWStalpers LJ: Surgical treatment of sphenoorbital meningiomas. Br J Ophthalmol 95:99610002011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Sandalcioglu IEGasser TMohr CStolke DWiedemayer H: Spheno-orbital meningiomas: interdisciplinary surgical approach, resectability and long-term results. J Craniomaxillofac Surg 33:2602662005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Scarone PLeclerq DHéran FRobert G: Long-term results with exophthalmos in a surgical series of 30 sphenoorbital meningiomas. Clinical article. J Neurosurg 111:106910772009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Schick UBleyen JBani AHassler W: Management of meningiomas en plaque of the sphenoid wing. J Neurosurg 104:2082142006

  • 20

    Shimizu STanriover NRhoton AL JrYoshioka NFujii K: MacCarty keyhole and inferior orbital fissure in orbitozygomatic craniotomy. Neurosurgery 57 (1 Suppl):1521592005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Shrivastava RKSen CCostantino PDDella Rocca R: Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management. J Neurosurg 103:4914972005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Terrier LMBernard FFournier HDMorandi XVelut SHénaux PL: Spheno-orbital meningiomas surgery: multicenter management study for complex extensive tumors. World Neurosurg 112:e145e1562018

    • Crossref
    • Search Google Scholar
    • Export Citation

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