Visual outcomes endorse surgery of patients with spheno-orbital meningioma with minimal visual impairment or hyperostosis

Amir H Zamanipoor Najafabadi,Stijn W Genders,Wouter R Van Furth

doi:10.1007/s00701-020-04554-9

Abstract

AbtractBackgroundMost spheno-orbital meningioma series span multiple decades, and predictors of visual outcomes have not yet been systemically assessed. We describe visual outcomes in a recent cohort and assess predictors of postoperative visual outcomes.MethodsConsecutive case series operated by a team of a neurosurgeon and orbital surgeon between May 2015 and January 2019. Best corrected visual acuity (BCVA), visual fields (static perimetry), and relative proptosis were measured preoperatively and postoperatively at 3/6/12 months after which it was assessed yearly. Predictors were assessed with linear regression analysis.ResultsNineteen patients (all WHO grade I) were operated by the pterional approach (median follow-up 2.4 years). Preoperative visual acuity deficits (n = 10) normalized in 70% and improved in 10% (median preoperative: 0.8, postoperative: 1.2, p = 0.021). Preoperative visual field deficits (n = 8) normalized in all patients (preoperative: − 6.5 dB, postoperative: − 1.5 dB, p = 0.008). Preoperative proptosis (n = 16) normalized in 44% and improved in 56% (preoperative: 5 mm, postoperative: 2 mm, p < 0.001). BCVA and visual fields remained stable at longer follow-up in 95% of patients, while 21% showed progression of proptosis. Predictors for worse longer-term (> 12 months) BCVA were worse preoperative BCVA (p = 0.002) and diagnosis of multiple meningioma (p = 0.021). Predictors for worse longer-term visual fields were higher diameter of hyperostosis (p = 0.009) and higher Simpson grade (p = 0.032). Predictor for short-term (3 months) proptosis was preoperative proptosis (p = 0.006).ConclusionWe recommend surgery, even of patients with minimal visual impairment or hyperostosis, as patients who present with deteriorated visual function or extensive hyperostosis are less likely to have postoperative visual outcomes restored to normal.

Highlights

Spheno-orbital meningioma (SOM) are tumors originating from the sphenoid ridge, primarily characterized by hyperostosis of the lesser and/or greater sphenoid wing [22, 28]
Consecutive spheno-orbital meningioma patients operated between June 2015 and January 2019 in the Leiden University Medical Center (LUMC) in Leiden the Netherlands were described in this study
20 patients were operated, but one patient was lost to follow-up, as the patient died due to comorbidities not related to the SOM or surgery

Summary

Introduction

Spheno-orbital meningioma (SOM) are tumors originating from the sphenoid ridge, primarily characterized by hyperostosis of the lesser and/or greater sphenoid wing [22, 28]. Due to the low incidence of SOM, current series in the literature describe smaller and larger patient series often covering multiple decades, while surgical techniques have improved over the years [3, 9, 14,15,16, 19, 21,22,23, 28, 31]. In these series, surgery has proven its value with improvement of visual function (10–73%) and proptosis (50–93%) [3, 9, Acta Neurochir (2021) 163:73–82. Identification of these predictors may optimize the decision and timing of surgical treatment and tailor postsurgical ophthalmological follow-up

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