2026 Poster Presentations
P028: ORBITAL PERIOSTEUM FINDINGS IN SPHENOID WING MENINGIOMAS
Angela Oh1; Timothy Lee1; Katherine Lucarelli1; Ben Glasgow1; Won Kim2; Daniel Rootman1; 1UCLA Stein Eye Institute; 2UCLA Department of Neurosurgery
Introduction: Medial sphenoid wing meningiomas often have an orbital component seen on imaging that can be resected at the time of surgery. Clinically, over 80% of patients can present with proptosis, which may be due to bony hyperostosis and/or soft tissue extension. The goal of the study was to understand how often the orbital periosteum is involved and if there are any clinical and radiologic features in these cases.
Methods: Case series of sphenoid wing meningiomas that underwent surgical resection including biopsy of the orbital periosteum. Patients were gathered from a single academic institution over a 3-year period and underwent transorbital surgery or craniotomy by neurosurgery and oculoplastics. Clinical characteristics and radiologic findings were collected. Patients were divided into those in which the periosteum demonstrated infiltration with meningioma and those that did not.
Results: 21 patients were included (81% female, mean age 59.3 years). Two patients had prior surgery including meningioma resection with recurrence and repeat biopsy.
15% presented with orbital pain and 35% had headache. Mean best corrected visual acuity for all was 0.8 logMAR. Proptosis was seen in all but two. Two patients were deceased at the time of data collection at a mean follow up time of 17.3 months. On imaging, 71% had bony hyperostosis and 65% had orbital soft tissue extension. Pathology was consistent with WHO grade I in fourteen cases, grade II in three, and grade III in three. 81% had periosteum/periorbital tissue positive for meningioma. Samples from the remaining four demonstrated fibroadipose tissue without evidence of tumor.
All negative biopsy patients were found to have Grade I meningioma. Mean logMAR was no different between groups (negative vs positive: 0.6 vs 1.0, p = 0.11). Proptosis was seen in 75% of those with negative biopsies compared to 94% of those with positive biopsies (p=0.37). Motility restriction was seen in 33% in both groups. None of the patients in the negative biopsy group had orbital pain or optic neuropathy compared to 19% and 31%, respectively in the positive biopsy group (p>0.05). All patients with negative biopsies had hyperostosis compared to 62% in the positive biopsy group (p=0.53). None of the patients with negative biopsies had orbital extension compared to 81% in those with positive biopsies (p = 0.007).
Conclusions: Sphenoid wing meningiomas with orbital periosteum positive for tumor are more likely to have orbital extension on imaging. All cases of negative orbital pathology in this cohort were Grade 1 meningiomas.