Predictive factors for visual outcome after resection of spheno‐orbital meningiomas: a long‐term review

Abstract

Editor, T he purpose of our study was to assess ophthalmological results in terms of visual acuity, reduction in visual field and proptosis and to compare this outcome to the radiological data and extent of surgical procedure in a retrospective cohort of 37 consecutive patients suffering from sphenoorbital meningiomas (SOMs) between 1 January 1986 and 31 December 2006. Data were collected from 37 women and three men aged between 33 and 76 years (mean age, 50 ± 9 years at diagnosis), with a mean follow-up of 7 ± 4 years. Mean preoperative visual acuity of the 37 patients was 0.31 ± 0.45 LogMAR, which did not significantly differ following surgery (0.25 ± 0.47 LogMAR) (p = 0.5). Visual acuity was observed to be normal in 15 patients (40.5%) for whom it remained stable during follow-up, with none of these patients experiencing any decrease in visual acuity following surgery. Among the 22 patients with initially altered visual acuity, 12 improved after surgery, five stabilized and five deteriorated. Neither initial proptosis nor initial visual acuity was a predictive factor for poor evolution of visual acuity. Similarly, no correlation was observed between initially altered visual acuity and final visual acuity (r = 0.11, p = 0.14). In terms of radiology, the initial effect on visual acuity signficantly correlated anatomically with involvement of the optic canal (p = 0.0033). The only negative factor identified for improved visual acuity during follow-up was the extension to the periorbit (Table 1). Initial proptosis and initial visual acuity were found to be negative predictive factors for final visual field defect. Preoperative integrity of the optic canal and cavernous sinus, as observed radiologically, was a predictive factor for having no final visual field defect. Finally, invasion of the optic canal and the presence of an intracranial soft-tissue component were both prodictors for severe final visual field defects. Proptosis was improved by surgical treatment, decreasing from 5.6 ± 3.6 mm preoperatively to 2.2 ± 2.7 mm postoperatively (p 2 mm,