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.
