Sphenoorbital Meningiomas: Orbital Reconstruction Parisa Azimi, Hassan Reza Mohammadi

Abstract

Background: To evaluate the technique of surgery in the treatment and reconstruction of sphenoorbital meningioma (SOM).

Materials and Methods: Patients undergoing surgery for SOM were included and were retrospectively assessed. The demographic and clinical characteristics of patients were extracted. Frontotemporal (pterional) craniotomy was performed. The greater wing of the sphenoid ridge was removed to the lateral limit of the lesser wing. When hyperostotic, the anterior clinoid was removed extradurally and the superior orbital fissure (SOF) was unroofed. The optic canal was unroofed, either intra- or extradurally, and the inferior optic strut was removed. When intracranial or intraorbital soft tissue was present, it was resected. Dural defects were reconstructed with autologous fascia lata. The roof and lateral wall of the orbit were reconstructed with titanium mesh. If there was a large cavity between the orbital and dural reconstruction and the cranioplasty, an autologous fat graft was used, and the sphenotemporal bone defect was covered with a titanium mesh cranioplasty.

Results: Six patients (6 females) and the median age were 45.6 years. Six patients had proptosis (mean±SD = 6.1±2.8 mm) and normal vision (n=2), decreased vision (n=3), and one patient had no light perception (NLP) at preoperatively. The left and right orbits were involved in 4 and 2 patients, respectively. A substantial reduction of proptosis was attained in all of patients. Surgery for patients with SOM improved vision in 3 of 4 cases (75%) and a patient who is NLP, remained unchanged.

Conclusion: The technique of reconstruction of SOM appears to be a safe and effective in patients and is recommended.

 Keywords: Sphenoorbital meningiomas, orbital reconstruction, surgery