Surgical management of spheno-orbital meningiomas

Abstract

We read with great interest the article entitled “Naturalhistory of spheno-orbital meningiomas” by Saeed et al. [3].The authors investigated the natural history and growth rateof spheno-orbital meningiomas (SOMs). They reported thata significant number of SOMs were slow-growing tumorsand that the initial volume of the tumor and of the softtissue component was significantly related to the growthrate. Therefore, they advocated a “wait and see” policy inthe absence of risk factors. We wish to provide furthercomment on the issue of surgical morbidity and mortality,which was anticipated by the authors, in the case of SOMs.Oya et al. [2] reviewed 39 patients who had SOMs and hadundergone surgery; they reported that persistent oculomotorpalsy occurred in three cases (7.7%). They avoided radicalresection of portions of the tumor that extended into thecavernous sinus (CS) and superior orbital fissure (SOF) inorder to minimize the risk of permanent oculomotor nervepalsy. Mirone et al. [1] also studied a series of 71 patientswho had undergone surgery for SOMs. They reported thatpersistent oculomotor palsy occurred in three cases (4.2%)and that there were no perioperative deaths related tosurgery. In their series, the CS and SOF constituted thesurgical limits in order to avoid the risk of permanentcranial nerve deficit. On the basis of these reports, weconsider that low morbidity and mortality rates can beachieved with surgery limited by the CS and SOF.Unfortunately, the biological behavior of SOMs varies,and some SOMs grow much faster than others [1, 3, 4].Therefore, we feel that good tumor control of SOMswithout morbidity is essential and that resection should belimited up to the CS and SOF to achieve adequate tumorresection with low morbidity.