1 Natural History and Surgical Outcomes of Single-Centre Experience in Management of Spheno-Orbital Meningiomas

Spheno-orbital meningiomas (SOM) are intracranial tumours arising from the sphenoid wing. Common presentations include visual impairment, exophthalmos, and headache. Gross-total resection (GTR) is difficult due to anatomical complexity. Subtotal resections (STR) present frequent residual progression. Adjuvant radiotherapy (aRT) is used for residual control but often causes radiation-induced neuropathies, necessitating individualized management strategies. Methods: Between 2001 and 2023, we screened 100 patients who underwent SOM resection at our institution. They were separated into two groups: surgery-only (S-only) versus surgery followed by aRT (S-RT). We analyzed clinical presentation, surgical outcomes, recurrence, and adjuvant outcomes. Results: 100 patients were included (68 S-only, 32 S-RT) with median age of 58.5 years. Mean follow-up was 66.1 months. Significantly more S-RT patients presented with exophthalmos (p=0.0095), optic neuropathy (p=0.0252), and retro-orbital pain (p=0.0166). S-RT lesions demonstrated more vascular encasement (p=0.0002), orbital involvement (p=0.0307), optic apparatus involvement (p=0.0187), and cavernous sinus invasion (p=0.0076). Higher rates of GTR was achieved in S-only cohort (p<0.0001), with 16.2% Simpson grade I (0% in S-RT; p=0.0150) and 51.5% Simpson grade II (18.8% in S-RT; p=0.0022). Regrowth and recurrence rates did not significantly decrease following aRT. Conclusions: Microsurgical management of SOM often results in STR. We report outcomes after maximal safe resection and document patterns of recurrences. Post-operative SOM progression tends to be delayed around the orbit. Thus, long-term surveillance and individualized planning by a multidisciplinary skull base team is crucial in achieving proper management.