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Predictive factors of the postoperative proptosis recovery in surgery of spheno-orbital meningiomas

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Abstract

Objective

This study aimed to identify factors affecting proptosis recovery in spheno-orbital meningioma (SOM) surgery and assess functional and oncological outcomes.

Methods

Data from 32 consecutive SOM surgery cases (2002–2021) were analyzed. Clinical, radiological, operative, and oncological parameters were examined. Proptosis was assessed using the exophthalmos index (EI) on MRI or CT scans. Statistical analyses were performed to identify predictive factors for proptosis recovery.

Results

Proptosis improved in 75% of patients post-surgery (EI decreased from 1.28 ± 0.16 to 1.20 ± 0.13, p = 0.048). Patients with stable or worsened EI had higher body mass index (28.5 ± 7.9 vs. 24.1 ± 4.7, p = 0.18), Simpson grade (IV 75% vs. 65%, p = 0.24), and middle sphenoid wing epicenter involvement (63% vs. 38%, p = 0.12), but no significant factors were associated with unfavorable exophthalmos outcomes. The improvement group had higher en plaque morphology, infratemporal fossa invasion, and radiation treatment for cavernous sinus residual tumor (88% vs. 75%, p = 0.25; 51% vs. 25%, p = 0.42; 41% vs. 25%, p = 0.42, respectively), but without statistical significance. Visual acuity remained stable in 78%, improved in 13%, and worsened in 9% during follow-up. Surgery had a positive impact on preoperative oculomotor nerve dysfunction in 3 of 4 patients (75%). Postoperative oculomotor nerve dysfunction was observed in 25%, of which 75% fully recovered. This occurrence was significantly associated with irradiation of an orbital tumor residue (p = 0.04). New postoperative trigeminal hypoesthesia was observed in 47%, of which 73% recovered. All SOMs were classified as WHO grade 1, and complementary treatments achieved oncological control, requiring gamma-knife radiosurgery in 53% and standard radiotherapy in 6%.

Conclusions

Surgery effectively improves proptosis in SOM, though complete resolution is rare. The absence of predictive factors suggests multifactorial causes, including body mass index and tumor resection grade. Postoperative oculomotor nerve dysfunction and trigeminal hypoesthesia are common but often recover. Gamma-knife radiosurgery maintains long-term oncological control for evolving tumor residue.

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Data availability

All data and materials used in this study are available upon reasonable request from the corresponding author.

Code availability

Any custom code or software developed for this research is available upon request from the corresponding author.

Abbreviations

ASA:

American society of anesthesiologists

BMI:

Body mass index

EI:

Exophthalmos index

OO:

Orbital opening

SOM:

Spheno-orbital meningioma

VA:

Visual acuity

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Author information

Authors and Affiliations

  1. Assistance Publique - Hôpitaux de Marseille, AP-HM, Hôpital Universitaire Nord, Neurochirurgie Adulte, Chemin Des Bourrely, 13015, Marseille, France

    Guillaume Baucher, Lucas Troude, Talal Al-Shabibi, Valentin Avinens & Pierre-Hugues Roche

  2. Faculté de Médecine, Unité d’Aide Méthodologique, Aix-Marseille Université, Marseille, France

    Sara Fernandes

Authors
  1. Guillaume Baucher
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  6. Pierre-Hugues Roche
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Contributions

The contributions of each author to this study are as follows:

Guillaume Baucher: design, data collecting, statistics, writing.

Lucas Troude: design, proofreading.

Talal Al-Shabibi: proofreading.

Valentin Avinens: proofreading.

Sara Fernandes: statistics, proofreading.

Pierre-Hugues Roche: design, supervision, proofreading.

Corresponding author

Correspondence to Guillaume Baucher.

Ethics declarations

Ethics approval

The protocol has been approved by the ethics committee of the French College of Neurosurgery (IRB00011687 #1: 2022/33).

Consent to participate

Informed and signed consent was obtained from all patients included in this study.

Consent for publication

All authors have given their consent for the publication of this research article.

Conflict of interest

The authors declare no competing interest.

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Publisher's Note

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Comments

The authors have undertaken a review of 32 cases of patients with spheno-orbital meningiomas at their institution over a 20-year period. They note in particular the evolution of proptosis following treatment in these cases. Proptosis improvement was seen in 75% of cases with worsening in a minority. The authors have made an important observation and identified BMI as a risk for lack of improvement (although not statistically significant) in proptosis which indicates multifactorial factors resulting in proptosis in these patients. Ultimately, the most important cause of proptosis is the reduction in orbital volume as a result of tumor invasion or compression of the orbit, and likely venous hypertension which may be the result of orbital involvement and cavernous sinus involvement. Adequate surgical resection thus may not result in reversal of proptosis. The authors should be commended for sharing their insights and experience with these difficult tumors.

William T. Couldwell

Salt Lake City, UT.

Appendix

Appendix

Fig. 6
figure 6

Flowchart of the study. We chose to exclude one patient due to early death (77-year-old male patient presenting postoperative status epilepticus with quick unfavorable evolution)

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Fig. 7
figure 7

Preoperative clinical symptoms other than proptosis in patients with spheno-orbital meningiomas, expressed as a percentage of the total of 32 patients (I., olfactory nerve; DVA, decreased visual acuity; III., oculomotor nerve; V., trigeminal nerve)

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Fig. 8
figure 8

Histology of spheno-orbital meningiomas (n = 32)

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Baucher, G., Troude, L., Al-Shabibi, T. et al. Predictive factors of the postoperative proptosis recovery in surgery of spheno-orbital meningiomas. Acta Neurochir 166, 164 (2024). https://doi.org/10.1007/s00701-024-06053-7

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