Advertisement

Acta Neurochirurgica

, Volume 161, Issue 8, pp 1657–1667 | Cite as

A single centre’s experience of managing spheno-orbital meningiomas: lessons for recurrent tumour surgery

  • Jonathan ShapeyEmail author
  • J. Jung
  • K. Barkas
  • R. Gullan
  • S. Barazi
  • R. Bentley
  • C. Huppa
  • N. W. Thomas
Original Article - Tumor - Meningioma
Part of the following topical collections:
  1. Tumor – Meningioma

Abstract

Background

Spheno-orbital meningiomas are complex tumours involving the sphenoid wing and orbit. Various surgical strategies are available but treatment remains challenging and patients often require more than one surgical procedure. This study evaluated whether smaller surgical approaches and newer reconstructive methods impacted the surgical and clinical outcomes of patients undergoing repeat surgery.

Methods

We retrospectively analysed the medical records of consecutive patients who underwent surgery for a spheno-orbital meningioma at a single tertiary centre between 2005 and 2016. We recorded procedural details and analysed complications, postoperative visual status and patient-reported cosmetic outcome.

Results

Thirty-four procedures were performed in 31 patients (M:F 12:22, median age 49 years) including 19 (56%) primary operations and 15 (44%) repeat procedures. Seven patients (20.5%) had a pterional craniotomy, 19 (56%) had a standard orbitozygomatic craniotomy and 8 (23.5%) underwent a modified mini-orbitozygomatic craniotomy. Calvarial reconstruction was required in 19 cases with a variety of techniques used including titanium mesh (63%), PEEK (26%) and split calvarial bone graft (5%). Total tumour resection (Simpson grade I–II) was significantly higher in patients undergoing primary surgery compared with those having repeat surgery (41% and 0%, respectively; p = 0.0036). Complications occurred in 14 cases (41%). Proptosis improved in all patients and visual acuity improved or remained stable in 93% of patients. Cosmetic outcome measures were obtained for 18 patients (1 = very poor; 5 = excellent): 1–2, 0%; 3, 33%; 4, 28%; 5, 39%. Tumour recurrence requiring further surgery occurred in four patients (12%). There was no significant difference in clinical outcomes between patients undergoing primary or repeat surgery.

Conclusion

Spheno-orbital meningiomas are highly complex tumours. Surgical approaches should be tailored to the patient but good clinical and cosmetic outcomes may be achieved with a smaller craniotomy and custom-made implants, irrespective of whether the operation is the patient’s first procedure.

Keywords

Meningioma Spheno-orbital meningioma Orbitozygomatic craniotomy Visual outcome Cosmetic outcome 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement of informed consent

This study was approved by the institution’s research committee without the need for informed consent.

References

  1. 1.
    Forster MT, Daneshvar K, Senft C, Seifert V, Marquardt G (2014) Sphenoorbital meningiomas: surgical management and outcome. Neurol Res 36(8):695–700PubMedCrossRefGoogle Scholar
  2. 2.
    Freeman JL, Davern MS, Oushy S, Sillau S, Ormond DR, Youssef AS, Lillehei KO (2017) Spheno-orbital meningiomas: a 16-year surgical experience. World Neurosurg 99:369–380PubMedCrossRefGoogle Scholar
  3. 3.
    Saeed P, van Furth WR, Tanck M et al (2011) Natural history of spheno-orbital meningiomas. Acta Neurochir 153(2):395–402PubMedCrossRefGoogle Scholar
  4. 4.
    Terrier LM, Bernard F, Fournier HD, Morandi X, Velut S, Henaux PL, Amelot A, Francois P (2018) Spheno-orbital Meningiomas surgery: multicenter management study for complex extensive tumors. World Neurosurg 112:e145–e156PubMedCrossRefGoogle Scholar
  5. 5.
    Rangel-Castilla L, Russin JJ, Spetzler RF (2016) Surgical management of skull base tumors. Rep Pr Oncol Radiother 21(4):325–335CrossRefGoogle Scholar
  6. 6.
    Agrawal A, Garg LN (2011) Split calvarial bone graft for the reconstruction of skull defects. J Surg Tech Case Rep 3(1):13–16PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Artico M, Ferrante L, Pastore FS, Ramundo EO, Cantarelli D, Scopelliti D, Iannetti G (2003) Bone autografting of the calvaria and craniofacial skeleton: historical background, surgical results in a series of 15 patients, and review of the literature. Surg Neurol 60(1):71–79PubMedCrossRefGoogle Scholar
  8. 8.
    Neligan PC, Boyd JB (1995) Reconstruction of the cranial base defect. Clin Plast Surg 22(1):71–77PubMedGoogle Scholar
  9. 9.
    Sahoo N, Roy ID, Desai AP, Gupta V (2010) Comparative evaluation of autogenous calvarial bone graft and alloplastic materials for secondary reconstruction of cranial defects. J Craniofac Surg 21(1):79–82PubMedCrossRefGoogle Scholar
  10. 10.
    Yadla S, Campbell PG, Chitale R, Maltenfort MG, Jabbour P, Sharan AD (2011) Effect of early surgery, material, and method of flap preservation on cranioplasty infections: a systematic review. Neurosurgery 68(4):1124–1129 discussion 1130PubMedCrossRefGoogle Scholar
  11. 11.
    Seckin H, Avci E, Uluc K, Niemann D, Baskaya MK (2008) The work horse of skull base surgery: orbitozygomatic approach. Technique, modifications, and applications. Neurosurg Focus 25(6):E4PubMedCrossRefGoogle Scholar
  12. 12.
    Hakuba A, Liu S, Nishimura S (1986) The orbitozygomatic infratemporal approach: a new surgical technique. Surg Neurol 26(3):271–276PubMedCrossRefGoogle Scholar
  13. 13.
    Pellerin P, Lesoin F, Dhellemmes P, Donazzan M, Jomin M (1984) Usefulness of the orbitofrontomalar approach associated with bone reconstruction for frontotemporosphenoid meningiomas. Neurosurgery 15(5):715–718PubMedCrossRefGoogle Scholar
  14. 14.
    Jumah F, Adeeb N, Dossani RH (2018) Collin S. MacCarty (1915-2003): inventor of the ‘MacCarty Keyhole’ as the starting burr hole for orbitozygomatic craniotomy. World Neurosurg 111:269–274PubMedCrossRefGoogle Scholar
  15. 15.
    Tubbs RS, Loukas M, Shoja MM, Cohen-Gadol AA (2010) Refined and simplified surgical landmarks for the MacCarty keyhole and orbitozygomatic craniotomy. Neurosurgery 66(6 Suppl Operative):230–233PubMedGoogle Scholar
  16. 16.
    Zabramski JM, Kiriş T, Sankhla SK, Cabiol J, Spetzler RF (1998) Orbitozygomatic craniotomy. J Neurosurg 89(2):336–341PubMedCrossRefGoogle Scholar
  17. 17.
    Tanriover N, Ulm AJ, Rhoton AL Jr, Kawashima M, Yoshioka N, Lewis SB (2006) One-piece versus two-piece orbitozygomatic craniotomy: quantitative and qualitative considerations. Neurosurgery 58(4 Suppl 2):ONS-229–ONS-237 discussion ONS-237Google Scholar
  18. 18.
    Lemole GM Jr, Henn JS, Zabramski JM, Spetzler RF (2003) Modifications to the orbitozygomatic approach. Technical note J Neurosurg 99(5):924–930PubMedCrossRefGoogle Scholar
  19. 19.
    Shah AM, Jung H, Skirboll S (2014) Materials used in cranioplasty: a history and analysis. Neurosurg Focus 36(4):E19PubMedCrossRefGoogle Scholar
  20. 20.
    Zanotti B, Zingaretti N, Verlicchi A, Robiony M, Alfieri A, Parodi PC (2016) Cranioplasty: review of materials. J Craniofac Surg 27(8):2061–2072PubMedCrossRefGoogle Scholar
  21. 21.
    Zhang Q, Yuan Y, Li X, Sun T, Zhou Y, Yu H, Guan J (2018) A large multicenter retrospective research on embedded cranioplasty and covered cranioplasty. World Neurosurg 112:e645–e651PubMedCrossRefGoogle Scholar
  22. 22.
    Bikmaz K, Mrak R, Al-Mefty O (2007) Management of bone-invasive, hyperostotic sphenoid wing meningiomas. J Neurosurg 107(5):905–912PubMedCrossRefGoogle Scholar
  23. 23.
    Boari N, Gagliardi F, Spina A, Bailo M, Franzin A, Mortini P (2013) Management of spheno-orbital en plaque meningiomas: clinical outcome in a consecutive series of 40 patients. Br J Neurosurg 27(1):84–90PubMedCrossRefGoogle Scholar
  24. 24.
    Cannon PS, Rutherford SA, Richardson PL, King A, Leatherbarrow B (2009) The surgical management and outcomes for spheno-orbital meningiomas: a 7-year review of multi-disciplinary practice. Orbit 28(6):371–376PubMedCrossRefGoogle Scholar
  25. 25.
    Civit T, Freppel S (2010) Sphenoorbital meningiomas. Neurochirurgie 56(2–3):124–131PubMedCrossRefGoogle Scholar
  26. 26.
    Franquet N, Pellerin P, Dhellemmes P, Defoort-Dhellemmes S (2009) Ophthalmologic characteristics of spheno-orbital meningiomas: a series of 23 surgical cases. J Fr Ophtalmol 32(1):16–19PubMedCrossRefGoogle Scholar
  27. 27.
    Heufelder MJ, Sterker I, Trantakis C, Schneider JP, Meixensberger J, Hemprich A, Frerich B (2009) Reconstructive and ophthalmologic outcomes following resection of spheno-orbital meningiomas. Ophthalmic Plast Reconstr Surg 25(3):223–226PubMedCrossRefGoogle Scholar
  28. 28.
    Honeybul S, Neil-Dwyer G, Lang DA, Evans BT, Ellison DW (2001) Sphenoid wing meningioma en plaque: a clinical review. Acta Neurochir 143(8):749–757 discussion 758PubMedCrossRefGoogle Scholar
  29. 29.
    Honig S, Trantakis C, Frerich B, Sterker I, Schober R, Meixensberger J (2010) Spheno-orbital meningiomas: outcome after microsurgical treatment: a clinical review of 30 cases. Neurol Res 32(3):314–325PubMedCrossRefGoogle Scholar
  30. 30.
    de JO, Toledo MM (2001) Surgical management of meningioma en plaque of the sphenoid ridge. Surg Neurol 55(5):265–269CrossRefGoogle Scholar
  31. 31.
    Leroy HA, Leroy-Ciocanea CI, Baroncini M, Bourgeois P, Pellerin P, Labreuche J, Duhamel A, Lejeune JP (2016) Internal and external spheno-orbital meningioma varieties: different outcomes and prognoses. Acta Neurochir 158(8):1587–1596PubMedCrossRefGoogle Scholar
  32. 32.
    Li Y, Shi JT, An YZ, Zhang TM, Fu JD, Zhang JL, Zhao JZ (2009) Sphenoid wing meningioma en plaque: report of 37 cases. Chin Med J 122(20):2423–2427PubMedGoogle Scholar
  33. 33.
    Marcus H, Schwindack C, Santarius T, Mannion R, Kirollos R (2013) Image-guided resection of spheno-orbital skull-base meningiomas with predominant intraosseous component. Acta Neurochir 155(6):981–988PubMedCrossRefGoogle Scholar
  34. 34.
    Mariniello G, Maiuri F, Strianese D, Donzelli R, Iuliano A, Tranfa F, de Divitiis E, Bonavolonta G (2008) Spheno-orbital meningiomas: surgical approaches and outcome according to the intraorbital tumor extent. Zentralbl Neurochir 69(4):175–181PubMedCrossRefGoogle Scholar
  35. 35.
    Mirone G, Chibbaro S, Schiabello L, Tola S, George B (2009) En plaque sphenoid wing meningiomas: recurrence factors and surgical strategy in a series of 71 patients. Neurosurgery 65(6 Suppl):100–109PubMedGoogle Scholar
  36. 36.
    Oya S, Sade B, Lee JH (2011) Sphenoorbital meningioma: surgical technique and outcome. J Neurosurg 114(5):1241–1249PubMedCrossRefGoogle Scholar
  37. 37.
    Ringel F, Cedzich C, Schramm J (2007) Microsurgical technique and results of a series of 63 spheno-orbital meningiomas. Neurosurgery 60(4 Suppl 2):212–214Google Scholar
  38. 38.
    Sandalcioglu IE, Gasser T, Mohr C, Stolke D, Wiedemayer H (2005) Spheno-orbital meningiomas: interdisciplinary surgical approach, resectability and long-term results. J Craniomaxillofac Surg 33(4):260–266PubMedCrossRefGoogle Scholar
  39. 39.
    Scarone P, Leclerq D, Heran F, Robert G (2009) Long-term results with exophthalmos in a surgical series of 30 sphenoorbital meningiomas. Clinical article J Neurosurg 111(5):1069–1077PubMedCrossRefGoogle Scholar
  40. 40.
    Schick U (2010) Sphenoorbital meningiomas: results in long-term treatment. HNO 58(1):37–43PubMedCrossRefGoogle Scholar
  41. 41.
    Shrivastava RK, Sen C, Costantino PD, Della Rocca R (2005) Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management. J Neurosurg 103(3):491–497PubMedCrossRefGoogle Scholar
  42. 42.
    Talacchi A, De Carlo A, D’Agostino A, Nocini P (2014) Surgical management of ocular symptoms in spheno-orbital meningiomas. Is orbital reconstruction really necessary? Neurosurg Rev 37(2):301–310PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryKing’s College HospitalLondonUK
  2. 2.Department of NeurosurgeryHellenic Red Cross HospitalAthensGreece
  3. 3.Department of Oral and Maxillofacial SurgeryKing’s College HospitalLondonUK

Personalised recommendations