Ophthalmologic outcome of 40 spheno‐orbital meningioma resections: 15 years long‐term results

Abstract

Abstract Purpose To evaluate the operative results of spheno‐orbital meningiomas regarding resectability, recurrence and ophthalmological outcome. Methods Retrospective study of 40 patients who underwent surgical resection of spheno‐orbital meningiomas followed by bony reconstruction between 1992 and 2008. Results Mean age of 50 years and sex ratio of 37 women and 3 men. The most common preoperative sign was proptosis (90%), visual acuity (VA) and visual field deficits (55%). Periorbital tumor infiltration is a predictive factor of decreased VA in case of initial VA deficit. Optic canal invasion and resection don’t influence VA recovery. Postoperatively, 10 patients showed severe permanent visual field deficits, versus 17 patients showed no visual field deficits. After surgery, proptosis improved for all patients with a preoperative mean proptosis of 5,6 +/‐ 3,6 mm versus 2,2 +/‐ 2,7 mm postoperatively (p<0,001). Lateral orbital wall resection and bony reconstruction are the two major factors which are efficient in reducing proptosis. Mean follow‐up period was 7 years. Clinical tumor recurrence was observed in 10 patients (27 %), radiological tumor recurrence without clinical signs was observed in 7 patients. 4 patients underwent re‐operation and 3 patients were treated by radiation. Resection quality is the only predictive factor of a clinical recurrence. Conclusion Periorbital tumor infiltration is a predictive factor of non‐improvement of visual deficits (VA or visual field deficits). Peri‐orbital resection leads to a better esthetic result with a better proptosis reduction. Complete and subtotal (> 90%) tumor resection gives a long‐term survival free of clinical recurrence for 80 % of our patients.