Surgical Management of Spheno-orbital Meningiomas En Plaque; Clinical and Radiological Outcome

Background: Spheno-orbital meningiomas en plaque are located in a complex areabetween the orbital and intracranial compartments and characterized by carpet likegrowth that infiltrate the dura mater and surrounding bone. Objective: Thisretrospective study analyzes the postoperative clinical and radiological outcome oftwenty three patients with spheno orbital meningiomas en plaque operated upon in theNeurosurgery Department, Cairo University Hospitals. Patients and Methods: Patientselection: patients with spheno orbital meningiomas en plaque. Operation: surgicalresection of the tumor, involved bones and periorbita via fronto-temporal approach.Results: Between Jan 2010 and December 2013, twenty three patients were operatedupon for treating spheno-orbital meningiomas en plaque via fronto-temporal approachand followed up clinically and radiologically for a mean of 18 months. During clinicalfollow up, improvement of proptosis was achieved in fifteen patients (78.9%) out ofnineteen patients presented with proptosis at a mean of 2 months postoperatively, visualimprovement occurred in seven patients (58.3%) out of twelve patients presented withdecreased visual acuity within the postoperative 2-12 weeks. Postoperatively, lid andorbital swelling occurred in all patients (100%), cranial nerve palsy in ten patients inwhich seven were transient (30.4%) and three were permanent (13%), subgaleal CSFcollection occurred in eleven patients (47.8%), intra cerebral hematoma in one patients(4.4%) and two patients (8.7%) developed postoperative fits. Radiological follow uprevealed total resection in sixteen patients (69.6%) and no recurrence was encountered.Conclusion: Spheno-orbital meningiomas en plaque are located in a complexanatomical region. Surgical management is not uniform and should be tailored to fiteach case. Radical tumor excision can be achieved by proper microsurgical dissection,aggressive bony removal and wide orbital decompression with low postoperativemorbidity, good clinical outcome and less rate of recurrence. However, greater samplesize and longer follow up would aid further documentation.