Microsurgical Treatment of Spheno-Orbital Meningiomas: The Clinical Significance of the Tumor Invasion into the Greater Sphenoid Wing

Objectives: The management of spheno-orbital meningiomas (SOM) is challenging due to complex characteristics of these tumours, such as extension into the orbit, hyperostosis of the greater sphenoid wing (GSW), and invasion of superior orbital fissure (SOF), cavernous sinus (CS), and optic canal. To address this challenge, this study reports the results of microsurgically treated SOM patients and the nuances that affect the surgical technique. Methods: The clinical data of 14 consecutive patients who underwent surgery through a microsurgical transcranial approach is collected retrospectively. Results: Among 14 patients, exophthalmos was present in all patients and facial numbness and visual acuity decline both in 50% of patients. Preoperative radiological imaging showed SOF narrowing in 7 cases, optic canal compression in 6 cases, and CS invasion in 5 cases. Our surgical technique relies on direct removal of affected GSW promoting the removal of temporal intradural tumor and decompression of lateral wall of the orbit, optic canal, and SOF. Total removal of GSW is found to be beneficial in treatment SOMs since tumor invasion to affected bone was met in all cases. Simpson grade 1 resection was achieved in 64% of cases. CS invasion present in 5 cases left intentionally unremoved. In two cases, second surgery was required, while in four cases, radiotherapy was necessary. Conclusions: Microsurgical treatment aiming for maximal safe resection with preservation of contents within the CS is the best option in the first-line treatment of SOMs. Aggressive removal of the bone tumor is beneficial in oncological control of disease.