SURG-13. Enhancing Spheno-orbital Meningioma Resection with Intraoperative Computed Tomography

Spheno-orbital meningiomas are rare skull base tumors that pose significant surgical challenges due to their partially intraosseous nature. Achieving complete resection is often difficult. To assess the utility of intraoperative CT in facilitating tumor removal, we conducted a retrospective analysis of surgically treated patients. A total of 24 surgical cases of spheno-orbital meningioma were retrospectively reviewed. In all cases, intraoperative CT imaging was used to evaluate the extent of intraosseous tumor resection. Tumor volume and degree of proptosis were assessed through pre- and postoperative imaging. Mean follow-up period was 46 months. In 38% of cases (9 patients), intraoperative CT revealed residual intraosseous tumor, prompting immediate re-resection. Excluding cases in which only partial tumor removal was intended, the mean extent of resection among the remaining 20 cases was 94% overall, with 99% for the intraosseous component. Preoperatively, 15 patients (63%) presented with proptosis, which was significantly reduced postoperatively (p < 0.001). Postoperative complications included transient oculomotor dysfunction in 29% of patients and trigeminal hypoesthesia in 8%. Revision surgery was necessary in 3 patients: 2 for cerebrospinal fluid (CSF) leakage and 1 for a surgical site infection. During follow-up, tumor recurrence or progression occurred in 7 patients (29%), and 8 patients underwent adjuvant radiotherapy. One patient required reoperation due to tumor recurrence. Thus, intraoperative CT proved to be a valuable tool for identifying residual intraosseous tumor, allowing for safe and more complete resection of spheno-orbital meningiomas. Its use may contribute to improved surgical outcomes and long-term disease control.