Spheno-orbital meningiomas: Surgical approaches and outcome according to the intraorbital tumor extent.

Objective This study proposes a topographical classification of spheno-orbital meningiomas. Its aim is to define wheter the different intraorbital localizations require different surgical approaches and have different recurrences rates and outcome. Methods Sixty patients with spheno-orbital meningiomas operated upon between 1983 and 2003 were reviewed. According to the intraorbital tumor extent, four types were identified: I: lateral or superolateral (15 cases); II: medial and inferomedial (8 cases); III: orbital apex (25 cases); IV: diffuse (12 cases). Three surgical approaches were used: lateral orbitotomy (15 cases with lateral or superolateral tumors), supraorbital-pterional approach (42 cases, including all 8 inferomedial, all 25 of the orbital apex, and 9 among 12 diffuse tumors), and fronto-temporal-orbitozygomatic approach (only 3 cases with diffuse meningiomas and large extent of the tumor in the infratemporal fossa and cavernous sinus). Results The tumor removal was complete (Simpson grades I and II) in 40 cases, and incomplete in 20 (33.3%). There were two postoperative deaths (3.3 %). A sufficient clinical follow-up was obtained in 52 cases. The clinical outcome was excellent in 26 patients (50%), good in 16 (30.8%), moderate in 6 (11.5 %), and poor in 4 (7.7 %). Twenty-two among 52 patients (42.3 %) had tumor recurrence; however, 44 (84.6 %) had tumor control after surgery alone through two or more operations. The recurrence rate was correlated with the Simpson grade of resection and the intraorbital tumor location. Significantly higher rate of recurrences were recorded in the orbital apex type (50 %) and diffuse forms (60 %), than in the inferomedial (28.5 %) and superolateral forms (23 %). Conclusions Spheno-orbital meningiomas may be classified according to the location and extent of the intraorbital tumor component. The different localizations may require different surgical approaches, with different chances of complete removal. The location and extent of the intraorbital tumor component result in different recurrence rates, lower for superolateral and inferomedial forms than for orbital apex and diffuse forms.