SPHENO-ORBITAL MENINGIOMA

Spheno-Orbital Meningioma

Spheno-Orbital Meningiomas are tumors with broad base meningeal origin arising from the sphenoid wing in the lateral skull base with an orbital or eye socket component. The tumor tends to invade the bone of the sphenoid wing and orbit and have an intra-orbital extension. The intracranial component of the tumor commonly has a thin carpet-like configuration against the temporal lobe without significant brain compression or swelling.

Symptoms

Spheno-Orbital Meningiomas tend to present with proptosis or eye-bulging, vision loss, and pain behind the eye socket.

Treatment

Spheno-Orbital Meningiomas Treatment generally requires surgical intervention for correction of the proptosis and visual difficulties. Radiation as a primary treatment is not recommended because of the extension of the tumor and proximity to the optic nerve. At the Meningioma Center, this tumor is managed by a neurosurgeon and an oculoplastic ophthalmologist for a maximal chance of a favorable outcome

Surgical Treatment at the Meningioma Center

At the Meningioma Center, we conceptualized the focal orbital approach which can be adapted for the removal of Spheno-Orbital Meningiomas. This approach associated with the extradural navigation concept allows access to the tumor without hazardous exposure to the brain and only minimal direct manipulation or retraction of it. The approach allows for early identification and decompression of the optic nerves for the best chance of visual recovery. Adequate resection of this tumor requires the removal of the intracranial, bone, and orbital components of the tumor. Reconstruction of the removed bone in the orbit and skull is necessary for the optimal cosmetic outcome.

Prognosis

Adequate surgical Treatment of Spheno-Orbital Meningiomas using the focal orbital approach and bone reconstruction can allow full or partial recovery of vision and correction of proptosis with optimal cosmetics. Patients may experience temporary double vision or difficulties opening the eye because of manipulation of the eye muscles during surgery. Maximal removal of the tumor including involved bone and meningeal broad origin of the tumor maximizes the chances of cure without tumor recurrence. Hard to reach tumor in the central orbit may not be possible to remove without unacceptable visual and cosmetic deficits. In these cases, post-operative Proton Bean Radiation Therapy may be needed.