Therapeutic Outcomes of Spheno-orbital Meningiomas and Factors Influencing Recurrence over a 32-Year Period

Purpose: To understand treatment outcomes and recurrence patterns of spheno-orbital meningiomas.

Methods: A single-center retrospective review from 1987 to 2019 was conducted. Recurrence was defined by deterioration of mean deviation (MD) on Humphrey visual field, progressive extraocular motility deficits (diplopia) or 20% increase in radiographic size.

Results: Thirty-six cases met inclusion criteria. The mean follow-up period was 94 months (range: 1–252 months). Patients underwent gross (45%), near- (24%), and sub-total resection (21%). Removal of the anterior clinoid process (ACP) occurred in 47%. The initial log Mar vision was 0.77 ± 1.08. Of cases with globe preservation, the final log Mar vision was 0.41 ± 0.86 with a MD improvement of 1.1 ± 4.1 dB. Loss of the eye occurred in 22% of cases. The mortality rate was 8.3%. Recurrence was seen in 53% at a mean interval of 52 months. 39% of patients had two or more recurrences. Histopathology at the first surgery revealed grades I (89%) and II (11%) and at the final surgery grades I (78%), II (19%), and III (3%). A subset of grade I patients receiving radiation behaved more aggressively (46%, 6/13), evolving to a higher grade (n = 4) or having multiple recurrences while remaining histologically grade I (n = 2). A subset analysis of 19 patients (53%) who received radiotherapy during the course of their treatment (grade I, n = 13, grade II, n = 6) was performed. Of the grade I who received radiotherapy for an early recurrence (n = 9) versus for later recurrence (n = 4), the mean time to subsequent recurrence or final follow-up was 53 versus 24 months (p = 0.630). A subset of grade I patients receiving radiation (46%, 6/13) behaved more aggressively, changing to a higher grade (n = 4) or having more than recurrences while remaining grade I histologically (n = 2). Worse postoperative vision (OR: 11.6, p = 0.026) and radiation treatment (OR: 21.0, p = 0.001) increased the odds of recurrence. Normal pupil exam at presentation (OR: 0.079, p = 0.026) and removal of the ACP (OR: 0.082, p = 0.002) decreased the odds of recurrence. Kaplan–Meier survival curves showed increased recurrence with grade 2 pathology (log-rank 0.017). Individuals with ACP removal had fewer recurrences (log-rank: 0.043).

Conclusion: Lifelong surveillance is prudent for detection of recurrences. ACP resection may positively affect tumor recurrence. Radiation therapy should be reserved for selected patients.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021