Surgery for Spheno-orbital Meningiomas: Should Orbital Walls Have to Be Reconstructed?

Abstract

Introduction: Orbital three-dimensional reconstruction is widely discussed in spheno-orbital meningioma (SOM) management specially since extended resections are recommended. Advocates of orbital reconstruction move forward restoration of orbital physiology, prevention of enophtalmos, and esthetic considerations. However, no study had compared these specific criteria in a population of SOM with or without orbital reconstruction. Methods: We report a 34 SOM series of which 16 cases had orbital walls reconstruction. Groups’ comparison was based on oculo-orbital index, heteroevaluation of cosmetic results by the Gaillard score (GS) and a self-evaluation cosmetic result index. Duration of surgical procedure and hospitalization, blood loss, ophthalmological, and sepsis complications were also compared. A subgroup study was performed depending on the number of orbital wall resected. Results: Analyse of groups or subgroups showed no significant difference for all items except for self-evaluation (reconstruction vs. no reconstruction, p = 0.0327). Excellent cosmetic result, GS superior to 7, was achieved in 73% of orbital reconstruction versus 50% in nonreconstructed group. Good cosmetic result, GS between 5 and 7, was reported in 40% of nonreconstructed group versus 13% in reconstructed group. Conclusion: Orbital reconstruction during surgery for SOM is a safety procedure. However, it does not significantly improve oculo-orbital index but it seems to achieve better cosmetic results.