2025 Poster Presentations
P037: MULTIDISCIPLINARY MANAGEMENT OF SPHENO-ORBITAL MENINGIOMAS
Evangelos Drosos, Mr1; Charlotte Hammerbeck-Ward, Ms2; Andrew T King, Prof1; Omar N Pathmanaban, Prof1; Saj Attaulah, Mr3; Paul S Cannon, Mr3; James Laybourne, Mr3; Nikolitsa Koutropoulou, Ms3; Andrea Wadeson, Ms1; Helen Entwistle1; Scott Rutherford, Mr1; 1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital NHS Foundation Trust, Salford, UK; 2Department of Neurosurgery, University Hospitals NHS FT, Royal Sussex County Hospital, Brighton, UK; 3Manchester University NHS FT, Royal Eye Hospital, Manchester, UK
Background/objectives: Spheno-orbital meningiomas (SOM) are rare entities with potentially significant impact on quality of life. In our unit these are managed in a multidisciplinary (MDT) service including neurosurgery and oculoplastic surgery which guides clinical assessment, radiological monitoring, management decision-making and surgical intervention.
Methods: Retrospective analysis of patients operated in a single centre by the SOM multidisciplinary team. The cohort includes patients reviewed between 2006-2024.
Demographics, pre- and post-treatment vision, tumour control and follow-up were recorded. Minimum follow-up of 6 months was required for inclusion.
Results: Overall 52 operations were recorded in 44 patients. Mean age at surgery was 49 with a large female preponderance. Eight patients had more than one operation.
The indication for surgery was compressive optic neuropathy causing visual deterioration in 65% of patients, followed by scan progression in 25%. Proptosis was the sole indication in 4 patients, while almost all patients had a degree of proptosis at the time of the operation.
Surgical resection in all cases involved maximal bony decompression of the visual pathway with lateral orbital wall decompression and anterior clinoidectomy. All involved dura and periorbita was excised except for tumour within the superior orbital fissure (SOF) and cavernous sinus. Orbital reconstruction was performed if >50% of the roof had been removed. All operations were performed by a joint surgical team of neurosurgeons and oculoplastic surgeons.
Total or near-total resection was achieved in 71% of operations. Surgical complications included 1 intraoperative lateral rectus trauma, 1 CSF leak, 2 surgical site infections and 5 patients with SOF dysfunction (only one of which was a persistent partial oculomotor palsy). Proptosis improved or resolved in 70% of patients. Histologically, 4 patients had WHO grade 2 tumours (2 of which were initially WHO grade 1); the remainder were all WHO grade 1.
Overall, 24 radiotherapy treatments were offered (42% of the patients) with 23 as adjuvant and 1 as primary. Adjuvant treatment occurred at a mean of 2 years (range 0-5) following surgery in the form of fractionated external beam radiotherapy.
Mean follow-up was 207 months (6-640 months). Tumour stability on the latest scan was seen in 90% of patients. Vision had improved or remained stable in 89% of patients at their last examination.
Conclusion: Spheno-orbital meningiomas present a rare and challenging entity that mandate multidisciplinary working. Surgery should aim for maximal safe resection focussing on wide bony decompression, with adjuvant radiotherapy playing an important role in tumour control. Long-term vision preservation and tumour control rates are very good with multidisciplinary management and multimodality treatment.