Orbital Meningioma Research Articles

Differences in merlin and p53 expression as a predisposing factor in orbital meningioma

Objectives: The behavior of orbital meningiomas is difficult to predict. The p53 tumor suppressor gene mutation and the neurofibromatosis 2 gene’s inactivation in the merlin formation are two of the several mechanisms that contribute to the development of tumors. This considers the comparison of merlin and p53 expression as an inclination to evaluate the orbital meningiomas. Materials and Methods: This investigation is an observational expository considered within the shape of cross-sectional (cross-sectional). The samples/objects of this study were 44 patients with orbital meningioma who had a clinical, radiological, and histopathological diagnosis at the anatomical pathology laboratory at Cicendo Eye Hospital and Hasan Sadikin Bandung in 2017–2020, then an immunohistochemical examination of merlin and p53 expression was performed. Results: The study indicated that there was no relationship between p53 expression and orbital meningioma grading, also there is no relationship between merlin expression and orbital meningioma grading. However, based on the analysis test results, grade 3 orbital meningiomas tended to have a positive p53 expression rather than a negative expression and tend to have a negative merlin expression instead of a positive. Conclusion: Meningiomas with negative merlin expression have a tendency to express positive p53. Likewise, the higher grade (grade 3) tends to express positive p53 and negative merlin, which may play a key role in tumorigenesis of orbital meningioma, hence, an added value for clinical information and behavioral descriptions of orbital meningioma itself.

CHARACTERISTIC OF PATIENTS WITH ORBITAL MENINGIOMA IN DR. KARIADI GENERAL HOSPITAL SEMARANG

Abstract
 Introduction & Objectives : Meningioma is a neoplasm arising from arachnoid cap cells in the meninges. They can arise in the orbit as primary or secondary orbital meningioma. The characteristic and risk factors of orbital meningioma are essential to acknowledge. The aim of this study is to describe the characteristic and risk factors of patients with orbital meningioma in Dr.Kariadi Hospital.
 Methods : A retrospective study was held from the medical record of patients with a diagnosis of meningioma between January 2020-December 2022. The data of 58 patients included age, sex, duration of proptosis, length of proptosis, history of seizure, diplopia, history of contraceptive and trauma, RAPD, fundus examination, and CT-Scan results.
 Results : Most of the meningioma patients had female 98,27%, 70,68% in the fourth decade of life. The visual acuity of 25,88% of patients >6/18, and 22,41% were blind. Around 72,41% of proptosis occurred ≥ 1 year, 87,93% had signs of headache, only 1,72% underwent seizure, 8,62% had double vision, and 5,17% had a history of head trauma. Relative afferent pupillary defect occurred in 53,44% of the affected eye with 20,68% atrophic papil and 15,51% edema papil. CT-Scan result of 86,2% had sphenoid meningioma, and only 13,79% had optic sheath meningioma. Most of the patients (72,41%) used 3 months cycle hormonal injection contraceptive.
 Conclusion : The characteristic of orbital meningioma patients in DR.Kariadi Hospital were mostly women in the fourth decade of life, had proptosis and headache as primary signs and 3 months of intramuscular hormonal contraceptives were suspected to have a correlation.

A Unique Case of Primary Subfrontal Lobe Meningioma with Intraorbital Extension

Introduction: Meningiomas, tumors originating from the meninges covering the brain, are typically considered benign. They primarily develop from arachnoid cap cells within the meninges and can manifest as primary orbital meningiomas (affecting structures like the optic nerve sheath) or secondary orbital meningiomas that extend from intracranial origins, such as the sphenoid wing and rarely from frontal lobe as in our case. Case Presentation: This report documents a very rare case where a meningioma emerged in the subfrontal lobe of the brain and subsequently spread to the orbit. The presence of such malignant variants in the orbit poses unique diagnostic challenges due to their potential to compress critical adjacent brain structures. Impact on Orbital Structures: The extension of these tumors into the orbit can have significant consequences, affecting structures like the cavernous sinus, superior orbital fissure, intraorbital contents, and the optic nerve. This further complicates their surgical management, given their proximity to essential neurological systems. Conclusion: This case study underscores the atypical growth pattern of malignant meningioma and highlights the complexities associated with identifying and treating meningioma with orbital extensions. The propensity of these tumors to impact vital brain structures necessitates a comprehensive approach to their diagnosis and management.

Clinical Characteristics and Prognostic Analysis of Osteolytic and Hyperostosis Sphenoid Orbital Meningiomas: A Single-Center Experience.

Reactive hyperostosis of spheno-orbital meningiomas (SOMs) often occurred in the sphenoid wing, while osteolytic SOMs (O-SOMs) were rarely discussed. This study preliminarily evaluated the clinical characteristics of O-SOMs and analyzed prognostic factors affecting the recurrence of SOMs. We retrospectively analyzed the medical records of consecutive patients who underwent surgery for a SOM between 2015 and 2020. According to the bone changes of sphenoid wing, SOMs were divided into O-SOMs and hyperostosis SOMs (H-SOMs). A total of 31 procedures were performed in 28 patients. All cases were treated by pterional-orbital approach. It was confirmed that 8 cases were O-SOMs and the other 20 cases were H-SOMs. Total tumor resection was performed in 21 cases. There were 19 cases with Ki 67 ≥3%. The patients were followed up for 3 to 87 months. Proptosis improved in all patients. All O-SOMs had no visual deterioration, while 4 H-SOMs cases had visual deterioration. There was no significant difference in clinical outcomes between the two types of SOM. The recurrence of SOM was related to the degree of resection, but not to the type of bone lesions, invasion of cavernous sinus and Ki 67.

Expressions of Progesterone Receptor of Orbital Meningiomas in Indonesia.

Visual disturbances that can heal after a complete resection of orbital meningiomas are only about 2.9%. Grading and expression of the progesterone receptor (PR) in orbital meningiomas, according to World Health Organization (WHO) is a useful predictive value of recurrence in the treatment management of orbital meningiomas. This study aims to determine the relationship of PR expression on the grading of orbital meningiomas as tumour prognostic factors. This cross-sectional observational analysis observed 44 orbital meningioma in Cicendo Eye Hospital Bandung and Hasan Sadikin Hospital between 2017-2020. We performed of mRNA PR with RT-qPCR technique and calculation with the 2∆∆Ct formula. Statistical analysis used the Kruskal-Wallis Test, followed by the Mann-Whitney post hoc test with p<0.005. Relative expression of mRNA PR in meningioma orbita grade I to grade III decreased significantly the expression of relative mRNA PR at grade I, II, III of 21.69±44.35, 20.39±26.30 and 1.25±0.85, with Kruskal-Wallis test, p =0.007. Mann Whitney's test results showed relative mRNA PR expression between grades I and II not different (p = 0.055), relative expression mRNA PR between grades I and III differed significantly (p = 0.024), and relative expression mRNA PR between grades I and III was not different (p = 0.638). mRNA PR expression is viable for prognostic value, predicting recurrence and implementing more effective management of subsequent therapy, it must be combined with other markers to determine the nature of the orbital meningioma.

Correspondence of Meningioma Orbital Grading and Clinicopathological Features among Indonesian Patients

BACKGROUND: Orbital meningiomas can cause visual disturbances, protrusion of the eyes, double vision, and optic nerve abnormalities that significantly decrease vision and eventually lead to blindness. To the best of our knowledge, data on the incidence and pathogenesis of orbital meningioma in Indonesia are non-existent. AIM: This study aimed to analyze the clinicopathological relationship with orbital meningioma grading. METHODS: It is a cross-sectional observational analysis on 44 orbital meningioma patients in Dr. Hasan Sadikin General Hospital and the National Eye Center, Cicendo Eye Hospital in 2017–2020. Chi-square analysis and logistic regression with statistical significance (p &lt; 0.05) were engaged in the method. RESULTS: Orbital meningioma mostly occurred in women aged 30–44 years. Meningioma Grade I was dominated by meningothelial meningioma found in 14 (31.8%) patients, Grade II was atypical meningioma in 9 (20.9%) patients, and Grade III was anaplastic meningioma in 3 patients (6.8%). Clinical symptoms in the form of papillary atrophy (p = 0.046), visual acuity (p = 0.026), proptosis (p = 0.029), and hyperostosis (p = 0.024) were statistically significant and there was a significant difference between Grade I, Grade II, and Grade III using the Chi-square test. Logistic regression results showed that hyperostosis is significantly related to grading the orbital meningioma (p = 0.044) with an odds ratio of 0.206 (IK95% 0.04–0.955). CONCLUSION: Hyperostosis increases the grading of the orbital meningioma because it is related to the invasion of the tumor into the orbital bone and is a neoplastic process. The presence of hyperostosis which is more common in Grade III meningiomas can be used as one of the most important predictors of meningioma recurrence postoperatively. Nonetheless, our data add to the existing literature the potential points of anti-invasive adjuvant therapy attacks.

Minimally invasive endoscopic approaches to pediatric skull base pathologies.

Endoscopic endonasal approaches to pediatric skull base lesions are rare, challenging, and present distinct considerations from adult pathology. In this study, we describe our endoscopic technical approach to various skull base lesions demonstrating the efficacy and nuances of these approaches in pediatric patients. Pediatric patients underwent endoscopic approach for skull base lesions from January of 2015 to April of 2021 were included in the study. Presenting symptoms, indications for surgery, surgical outcomes, intraoperative and postoperative complications, length of hospital stay, and length of follow-up were documented. A total of 18 patients (median age 12, age-range 1-15, 53% male) underwent 19 endoscopic transsphenoidal procedures. The pathologies included craniopharyngioma (N=5), biopsy for an unknown disease (n=2; orbital meningioma and pituitary lymphocytic hypophysitis), pituitary adenoma (N=2; ACTH-secreting and non-functional), Rathke's cleft cyst (n=2), CSF leak repairs (n=2; post-traumatic and spontaneous meningocele), juvenile nasopharyngeal angiofibroma (n=3, 1 patient had 2 procedures) and rhabdomyosarcoma (n=1). GTR was achieved in 11 out of 15 procedures (73.3%). Out of 10 patients with a sellar lesion, 6 patients had intraoperative CSF leak (60%). No patients experienced post-operative CSF leak. The median follow-up for all patients was 14 months (1-36 months). Anterior and middle skull base pathology in pediatric patients can be effectively operated via an endoscopic approach across a wide variety of patient ages and conditions. Minimally invasive techniques with middle turbinate and nasal septum preservation can be achieved without compromising outcomes. A wide variety of surgical repair strategies can be successfully utilized.

Orbital Meningioma Revealed by Papilledema: Case Report and Review of the Literature

Orbital meningioma is a rare benign tumor, it develops from the dura mater and can invade the opposite bone and invade the orbital contents through the superior orbital fissure or optic canal, or more frequently after bone invasion. It frequently occurs in the spheno-orbital region, rarely in the frontal location, as in our case. This is a 58-year-old woman with no pathological antecedents. She consulted with our ophthalmology service with progressively installing low visual acuity with binocular diplopia. Examination of the right eye reveals exophthalmos axial, painless, non-reducible and non-pulsatile, as well as limitation of ocular motility in lateral gaze. Fundus examination showed grade 1 papilledema. Orbitocerebral scanner was favorable for frontal meningioma with grade 1 exophthalmos. Pariente was referred to neurosurgery for possible surgical excision.

Simultaneous vestibular, orbital, meningeal and medullary involvement in a patient diagnosed with neurofibromatosis type 2

Neurofibromatosis Type 2 (NF2) is an autosomal dominant genetic disease characterized by the presence of bilateral vestibular schwannomas. We report the case of a 21-year-old patient, followed up for neurofibromatosis type 2, operated two times for right parietal and orbital meningioma that complained for headache and dizziness, referred to us for brain and cervical MRI exploration including 3D-FIESTA sequence. MRI completed by CT scan noted intraosseous and cerebral extra-axial meningiomas, bilatetal shwannomas and cervical epedymomas. Neurofibromatosis type 2 is a genetic disease with nervous system lesions and MRI is important for their exploration.

English

BACKGROUND Computer tomography (CT) plays a crucial role in elucidating the etiological diagnosis and identifying the extent of orbital lesions related to thyroid eye disease, cellulitis, orbital osteomyelitis, bone tumours, mucocele, orbital varices and cavernous hemangioma. This study was intended to assess the diagnostic utility of CT in patients presenting with orbital lesions. METHODS We enrolled 30 consecutive patients presenting with orbital lesions, who underwent complete ophthalmological, systemic examination, computerized tomography, and other appropriate systemic investigations over one year period. RESULTS In our clinical cohort of 30 patients, the spectrum of encountered orbital lesions included thyroid eye disease in 8 (26.6 %), orbital fractures in 5 (16.6 %), pre-septal hematoma in 3 (10 %), cellulitis in 3 (10 %), lymphoproliferative lesions in 2 (6.6 %), orbital lymphomas in 2 (6.6 %), orbital mucocele in 2 (6.6 %) cavernous hemangioma in 1 (3.3 %), frontal bone osteomyelitis in 1 (3.3 %), orbital varices in 1 (3.3 %), osteoma in 1 (3.3 %) and orbital meningioma in 1 (3.3 %) patients. Proptosis was observed in 22 (77 %) patients. On CT imaging, lesion attenuation was hyperdense in 28 (92 %) and isodense in 2 (8 %) patients. Lesions were extraconal in 19 (63 %), conal in 8 (27 %) and intraconal in 3 (10 %) patients. Extraocular muscle involvement was seen in 8 (27 %) and bone involvement in 11 (37 %) cases. CONCLUSIONS Computerized tomography in the orbital lesions accurately established the nature and extent of lesions. In 100 % of cases, CT was helpful in deciding appropriate systemic investigations to establish the etiological diagnosis. KEY WORDS Computerized Tomography, Orbital Lesions, Etiological Diagnosis.

Surgical Treatment of Recurrent Spheno- Orbital Meningioma.

The extensive bone infiltration and carpet-like growth characteristics of spheno-orbital meningioma (SOM) make it hard to remove entirely, and recurrence and proptosis are the main reasons for reoperation. The authors report 20 cases of surgical treatment for recurrence of SOM, including surgical technique and symptom improvement. The clinical data and follow-up results of 20 cases of recurrent SOM at our institution from 2000 to 2017 were retrospectively analyzed. All of the 20 patients with recurrence had received at least one operation before admission, with a mean age of 56 years and 70% female. The mean follow-up time was 36 months (172 months). All patients mainly showed symptoms such as proptosis and headache, and were found to be affected by supraorbital fissure during the operation. in 17 patients with recurrence, the affected sphenoid wing became tumor-like hyperplasia. Patients with extraocular muscle involvement have obvious protrusion and are often accompanied by diplopia. After surgical removal of the tumor, the symptoms of proptosis in 19 patients were significantly improved. During the follow-up, only 3 cases of proptosis recurred. After 15 patients underwent Simpson grade IV resection, 4 patients (27%) relapsed again. Five patients underwent Simpson III resection, and only 1 patient (20%) had tumor recurrence 18th months after surgery, and no proptosis recurred. The complete surgical removal of recurrent SOM is practically impossible. The main direction of surgical treatment should be to improve the symptoms of proptosis.

Isolated Intraconal Meningioma

Purpose To report a rare case of isolated intraconal meningioma.Case Report A 24-year-old woman presented with painless proptosis in her left eye which started and progressed during her pregnancy about 10 months ago. Hertel exophthalomometry revealed anterior displacement of the globe with 4 mm of proptosis which was remarkable. Magnetic resonance imaging (MRI) demonstrated an intraconal circumscribed oval-shaped mass with hypointense signals on T1-weighted images and hyperintense signals on T2-weighted images, mimicking cavernous hemangioma. This mass, however, was free of any connections to optic nerve or bones. Due to the imaging characteristics, more prevalent diagnoses like cavernous hemangioma were placed on the top of the differential diagnoses list. However, during the surgical excision, the tumor’s consistency and gross features were not compatible with cavernous hemangioma. The pathologic findings instead determined meningotheliomatous meningioma, a very rare condition, which was far from our expectations prior to the surgery.ConclusionEctopic orbital meningiomas are rare tumors that are not easily diagnosed without postoperative histopathology. Despite its low prevalence, they should be considered in the differential diagnosis list of intraconal masses with hypointense signals on T1-weighted images and hyperintense signals on T2-weighted images.

Ectopic intraconal orbital meningioma – A rare case report

Background: Ectopic orbital meningiomas (OM) are a rare subset of OMs which are neither attached to the optic nerve sheath nor to the surrounding bone.Case Description: We report the case of a 65-year-old female who presented with a 1 year history of proptosis followed by visual loss and restricted right eye movements since 3 months. Radiology of the orbits was suggestive of intraorbital, intraconal, and heterogeneous contrast enhancing right eye lesion which was completely excised through supraorbital orbitotomy approach. Intraoperatively, the right optic nerve, though compressed, and displaced inferiorly, was free from the lesion. The final histopathological diagnosis was “Meningioma WHO Grade I.” At 3 months follow-up, patient’s vision in the right eye improved from perception of light positive to 6/12 and there was no evidence of recurrence.Conclusion: Rarity of ectopic OM, total surgical excision with an excellent postoperative visual outcome prompted us to report this case.

Primary extradural ectopic orbital Meningioma.

Orbital meningioma is a rare benign tumor. However, the existence of ectopic orbital meningiomas was debated for long time and this lesion might be underreported. Complete surgical excision could achieve a good prognosis without visual impairment. The recurrence rate is still considerable. The aim of this report was to highlight the diagnostic difficulties and management characteristics.

Comparison of diagnostic value of 68\xa0Ga-DOTATOC PET/MRI and standalone MRI for the detection of intracranial meningiomas

To evaluate the diagnostic performance of magnetic resonance imaging (MRI) alone in comparison to positron emission tomography/ magnetic resonance imaging (PET/MRI) in patients with meningiomas. 57 patients with a total of 112 meningiomas of the brain were included. PET/MRI, including a fully diagnostic contrast enhanced MRI and PET, were acquired. PET/MRI was used as reference standard. The size and location of meningiomas was recorded. Likelihood-ratio chi-square tests were used to calculate p-values within logistic regression in order to compare different models. A multi-level logistic regression was applied to comply the hierarchical data structure. Multi-level regression adjusts for clustering in data was performed. The majority (n = 103) of meningiomas could be identified based on standard MRI sequences compared to PET/MRI. MRI alone achieved a sensitivity of 95% (95% CI 0.78, 0.99) and specificity of 88% (95% CI 0.58, 0.98). Based on intensity of contrast medium uptake, 97 meningiomas could be diagnosed with intense uptake (93.75%). Sensitivity was lowest with 74% for meningiomas < 0.5 cm3, high with 95% for meningiomas > 2cm3 and highest with 100% for meningiomas 0.5–1.0 cm3. Petroclival meningiomas showed lowest sensitivity with 88% compared to sphenoidal meningiomas with 94% and orbital meningiomas with 100%. Specificity of meningioma diagnostic with MRI was high with 100% for sphenoidal and hemispherical-dural meningiomas and meningiomas with 0.5–1.0 and 1.0–2.0 cm3. Overall MRI enables reliable detection of meningiomas compared to PET/MRI. PET/MRI imaging offers highest sensitivity and specificity for small or difficult located meningiomas.

Large Orbital Tumor in a Patient with Neurofibromatosis Type 2

Neurofibromatosis type 2 (NF2) is a separate entity from Neurofibromatosis type 1 (NF1) or von Recklinghausen’s disease, and is much less frequent than NF1. Vestibular schwannomas are the hallmark lesion, affecting 95% of individuals and typically occur bilaterally. Schwannomas commonly occur on other nerves intracranially and in the spinal compartment, along with meningiomas, ependymomas, and gliomas. Ophthalmologic abnormalities are present in the majority of NF2 patients, including cataracts, retinal changes, optic nerve sheath meningiomas and other optic pathway tumors. These tumors are sometimes large and can induce significant proptosis. We report the case of a large orbital meningioma responsible for severe proptosis in a patient with NF2.

Long-term outcome in orbital meningiomas: progression-free survival after targeted resection combined with early or postponed postoperative radiotherapy.

In meningiomas involving the orbit and optic canal, surgery is the mainstay of therapy. However, radical resection is often limited to avoid functional damage, so multidisciplinary treatment concepts are implemented. Data on the timing and value of early postoperative radiotherapy (PORT) are scarce. This retrospective study analyzes outcomes in patients who underwent targeted resection alone or in combination with early PORT. Patients undergoing resection of orbit-associated WHO grade I meningiomas from January 1999 to December 2013 who presented to the authors' department at least twice for follow-up were included. Clinical and radiological findings were analyzed retrospectively. Patients were stratified into two cohorts: follow-up with MRI scans at regular intervals, i.e., the watch and wait (W&W) group, and a PORT group receiving PORT within 6 months after surgery in addition to MRI follow-up. Patients in the W&W group were scheduled for treatment when tumor progression was detected by imaging. One hundred twenty-two patients were included. The mean follow-up was 70 months. The most common symptoms at presentation were visual disturbances; 87.7% of patients received Simpson grade II-III targeted partial resection. Twenty-three patients received PORT, and 99 patients were regularly observed with MRI scans (W&W group). Tumor recurrence/progression occurred significantly later (76.3 vs 40.7 months) and less frequently in the PORT group (13%) than in the W&W group (46.5%). Cases of recurrence were diagnosed an average of 39 months after initial surgery in both groups. PORT patients demonstrated significantly less visual impairment at last follow-up. These results indicate that receiving PORT early after targeted partial resection might help to postpone tumor recurrence and the need for additional treatment, while preserving or even improving visual outcome.

Ectopic orbital meningioma: a retrospective case series

BackgroundTo evaluate the ophthalmic manifestations and radiographic features of ectopic orbital meningioma to improve diagnostic accuracy.MethodsPatient data from patients admitted to our institution during a 217-month period from August 1999 to September 2017 were included. Patient ophthalmic manifestations, radiographic features (CT and MRI), diagnosis, pathology, therapeutic regimens, and prognosis were retrospectively reviewed.ResultsSix patients with ectopic orbital meningioma were identified. The mean age at the first visit was 33.2 years (range, 7–56 years). All six patients displayed manifestations of exophthalmos, upper eyelid oedema, and motility impairment with a mean history of illness of 20.3 months (range 3–72 months). Optical lesions were located in the superonasal extraconal compartment (3/6, 50%), bitemporal extraconal compartment (1/6, 16.7%) and orbital intraconal compartment (2/6, 33%). Radiographic features were ill-defined, heterogeneous, enhancing soft tissue masses with extraocular muscular adhesion (6/6, 100%) and calcification (1/6, 16.7%), not adjacent to the optic nerve and not extending along the dura. Six cases were treated intraoperatively with complete surgical resection, indicating that all lesions were independent of the optic nerve and sphenoid ridge. The histopathologic classification was mostly of meningothelial cells (5/6, 83%). Immunohistochemistry revealed EMA and vimentin to have positive expression in all six cases, while two cases were calponin-positive and strongly expressed in the olfactory bulb. Postoperatively, lesions caused no visual impairment, and there were no cases of recurrence.ConclusionsEctopic orbital meningiomas are rare tumours that are not easily diagnosed without postoperative histopathology. This report highlights some of the distinguishing features of isolated orbital lesions, especially around the location of frontoethmoidal suture. Accompanying upper eyelid oedema and eye mobility restriction were observed to be dissimilar to other orbital tumours. In these cases, a diagnosis of ectopic orbital meningioma should be considered.

Intra-Orbital Meningioma Causing Loss of Vision in Neurofibromatosis Type 2: Case Series and Management Considerations.

Objectives: Little evidence exists regarding the management of orbital meningioma causing vision loss in the setting of neurofibromatosis Type 2 (NF2). We review here our experience with patients at risk for blindness due to intra-orbital meningioma.Design/Setting/Participants/Main Outcome Measures: The charts of patients with NF2 presenting for evaluation of intra-orbital meningioma and vision impairment between 2008 and 2013 were retrospectively reviewed in accordance with institutional IRB policies. Patients with primarily extra-orbital tumors and minimal intra-orbital extension were excluded. Charts were analyzed for the presence and/or imaging progression of intra-orbital tumor, presence of other optic apparatus pathology, presence and/ or progression of vision impairment, and intervention performed (if any).Results: Seven patients with intra-orbital meningioma on MRI and bilateral vision loss and/or unilateral visual impairment due to tumor and contralateral blindness of any etiology were identified. Patients without salvageable vision in either eye were excluded (n = 3). Diagnosis of meningioma was obtained either by biopsy or based on imaging assessment.Conclusion: Conservative management of orbital tumors in NF2 may be preferred in asymptomatic patients but may not be acceptable in patients with progressive visual decline. Radiation is a reasonable option for meningiomas of the orbit and optic nerve sheath. Finally, although the benefit of cranial nerve decompression in NF2 for preservation of facial nerve and hearing has previously been established, the role of optic nerve decompression for preservation of vision in NF2 remains poorly defined.

Orbital Meningiomas

Orbital meningiomas usually invade the orbit as an extension of the sphenoid wing meningiomas, clinoidal meningiomas, cavernous sinus meningiomas and tuberculum sella tumors. They also arise into the orbit originating from the optic sheath or as ectopical lesions. The authors present a review of clinical aspects and surgical treatment of the orbital meningiomas. Material and methods: The authors present a literature review of the anatomical, clinical, and surgical aspects of the orbital meningiomas, add illustrative cases, pointing their principal concerns about the treatment of such tumors. Results: Exophthalmos and unilateral visual loss are the most common features of the orbital meningiomas. There are two important surgical routes to approach such tumors, which are extracranial (transorbital) and transcranial approaches. Recurrence is higher in sphenoorbital meningiomas and related to bone and neurovascular invasion. Conclusions: The anatomical structures involved by orbital meningiomas challenge the microsurgical resection. Total removal should be the goal at the first surgical approach. Orbital reconstruction should be performed in cases where the orbital floor is not preserved or in extensive lateral and roof removal with no preservation of the periorbit.