Spheno-orbital Meningiomas: Case Series and Surgical Outcomes following Frontotemporal-Orbitozygomatic Craniotomy

Introduction: Spheno-orbital meningiomas (SOM) pose significant surgical challenges due to their anatomical relationship with the orbit and critical neurovascular structures. Clinically, patients often present with visual symptoms, including proptosis and blurred vision, as well as generalized symptoms such as headaches or seizures secondary to mass effect and edema. This study aims to evaluate the outcomes of patients with SOMs managed with a frontotemporal-orbitozygomatic (FTOZ) skull base craniotomy, providing insights into outcomes and follow-up results. Methods: A retrospective chart review was conducted for patients who underwent an FTOZ performed by a single skull base neurosurgeon with over 30 years of experience. Patients were included if they had a meningioma on final pathological diagnosis. SOMs were defined based on the location of the tumor on the sphenoid bone and the orbit, including evidence of hyperostosis on CT scans. Patients’ demographic data, pathological diagnosis, operative notes, and clinical follow-up data were recorded from electronic medical records. FTOZ craniotomies were uniformly performed as previously published with an interfascial dissection technique. Results: Case review revealed 130 patients who underwent FTOZ craniotomies. Ten patients were included, eight females and two males, based on the initial chart review performed to date. The average age at the time of surgery was 54.5 ± 9.9 years, with a symptom duration of 1.6 ± 1.9 years. Fifty percent of patients had visual symptoms, and 30% had seizures and headaches. Retinal nerve fiber layer (RNFL) thickness data were available for four patients. Two of these patients had visual deficits, and their RNFL thickness on the affected side was decreased by 29.7 and 16.3% compared to their contralateral retina. The average size of the tumors was 4.1 ± 0.8 cm in the largest dimension, and 50% of them involved the cavernous sinus. Four patients received a Simpson grade IV resection, and the remainders were between grades I-III, distributed evenly. WHO grade II atypical meningiomas were found in 50% of the patients, and all but one (due to patient preference) received postoperative radiation therapy. Radiographic tumor recurrence was noted in one patient after 4.5 years of stable disease with a WHO grade II tumor. Visual acuity improved in all patients who had deficits preoperatively. The average length of follow-up was 2.7 ± 2.2 years from the time of surgery. Conclusion: SOMs pose a formidable challenge to skull base neurosurgeons. Presently, very few studies exist that classify these tumors based on anatomy and ophthalmological assessment. Our next steps include detailed radiographical and clinical phenotyping of all SOMs managed at our center to guide surgical management and improve predictors of symptom improvement. We will utilize Bayesian neural networks to form classification schemas to better characterize these lesions anatomically and clinically. Publication History Article published online: 07 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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