2026 Poster Presentations
P122: HORMONE THERAPY FOR SPHENOORBITAL MENINGIOMAS: EVIDENCE, CHALLENGES, AND PROSPECTS
Kivanc Yangi, MD; Jarett E Prince, BS; Michell Goyal, BS; Kashif Qureshi, MS; Jack T Olson, BS; Doga D Demir Yangi, MD; Egemen Gok; Mark C Preul, MD; Barrow Neurological Institute
Background and Objective: Sphenoorbital meningiomas (SOMs) are a rare and distinct subset of skull base tumors, accounting for up to 9% of intracranial meningiomas. They originate from the sphenoid wing and often extend posteriorly into the cavernous sinus and anteriorly into the orbital apex, creating complex anatomical challenges. SOMs typically include both intraosseous and soft tissue components, most often manifesting as sphenoid wing hyperostosis with diffuse, carpet-like soft tissue infiltration. Similar to other meningioma subtypes, hormonal influences are increasingly recognized in SOMs; however, their highly challenging location has made this relationship particularly important in recent years. This study examined the association between hormone therapy (HT) and the development, progression, and treatment response of SOMs, while also outlining current gaps in clinical evidence.
Methods: A systematic literature review searched PubMed, Embase, SCOPUS, and Cochrane databases for English-language articles. Study selection adhered to PRISMA guidelines. Eligible studies included those containing original research on both HT exposure and SOMs. The quality of each study was assessed using the Joanna Briggs Institute critical appraisal tools. In addition, one formalin-fixed, latex-injected cadaveric head was dissected and photographed to demonstrate relevant middle fossa anatomy.
Results: 20 studies were identified, of which 10 met the inclusion criteria. These included 2 case reports, 1 prospective cohort, and 7 retrospective cohorts, covering 315 patients with SOMs. Mean patient age was 49.6 ± 4.47 years, with a marked female predominance (258 patients, 81.9%). Where specified, lesions were classified as WHO Grade I or II. Reported Ki-67 indices ranged from <1% to 5%. The most frequent symptoms were proptosis, headache, and visual disturbances. Among 6 studies reporting laterality, 98 patients had unilateral and 22 had bilateral tumors. On average, patients had 12.6 ± 3.67 years of HT exposure, with progestins representing 90% of cases. 6 studies documented tumor volume reduction after HT withdrawal; in 4, regression was confined to the soft tissue component, while the intraosseous component remained stable or progressed. Surgical resection was the main treatment modality. Subtotal resection was associated with a higher recurrence rate, especially when residual soft tissue persisted. In selected cases, conservative management with HT discontinuation was reported. Data on progesterone receptor (PR) status and radiotherapy were limited.
Conclusions: Despite the clinical importance of HT in SOMs, only a limited number of structured, systematic studies have addressed this issue, generating comprehensive data to inform treatment. Current evidence suggests that HT, especially long-term progestin use, may contribute to the development and progression of SOMs. Withdrawal of HT has been associated with partial regression, primarily in soft tissue components, though surgical resection remains the primary treatment modality. Combined strategies incorporating HT cessation alongside surgery may be beneficial in select cases, but prospective data and standardized guidelines are still needed.