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.

 

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

Publication History

Article published online:
12 February 2021