Orbital decompressive effect of endoscopic transorbital surgery for sphenoorbital meningioma
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OCULOPLASTICS AND ORBIT
Orbital decompressive effect of endoscopic transorbital surgery for sphenoorbital meningioma Kyung In Woo 1
&
Doo-sik Kong 2 & Ji Woong Park 1 & Minsoo Kim 2 & Yoon-Duck Kim 1
Received: 25 July 2020 / Revised: 20 October 2020 / Accepted: 2 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose This study was aimed at evaluating the orbital decompressive effect of endoscopic transorbital approach (TOA) in the management of sphenoorbital meningioma involving the orbit. Methods Patients treated with TOA for this tumor from December 2016 to December 2019 were included, and the data were reviewed. Pre- and postoperative clinical and imaging findings were compared with a volumetric study. Results Eighteen patients (two men and 16 women) were included. Lateral wall hyperostosis (13 patients), extraconal tumor infiltration (18 patients), intraconal tumor infiltration (seven patients), and superior and lateral rectus encasement (nine patients) were found. Intraconal tumor infiltration in the posterior orbit affected compressive optic neuropathy (CON) more often than other tumor manifestations. The orbital soft tissue volume decreased to 91.18% ± 8.19% compared to that in the contralateral side preoperatively. The postoperative volume increased to 113.73% ± 12.92% compared to the preoperative volume. The average values of LogMAR visual acuity and visual field index score of ten patients with CON improved from 0.80 to 0.42 and 48.9 to 65.9%, respectively. All 17 patients with proptosis showed improvement after surgery. There were no significant complications associated with the surgery. Additional treatment, including gamma knife surgery, was applied to 12 cases for the remaining tumor. Conclusion This minimally invasive surgical debulking procedure was successful in treating sphenoorbital meningioma without significant adverse events. Lateral orbital wall decompression and limited intraorbital tumor resection were effective for compressive orbitopathy from the tumor.
Key Messages: Sphenoorbital meningioma is challenging to treat because of its specific growth pattern and involvement of vital structures in the skull base and orbital apex. The newly introduced transorbital endoscopic approach is a minimally invasive and efficient procedure to manage sphenoorbital meningioma. Posterolateral orbital wall decompression is effective for compressive optic neuropathy even with unresectable intraconal meningioma which is treated with additional therapies, such as Gamma Knife Surgery.
Kyung In Woo and Doo-sik Kong equally contributed to this manuscript as first authors. Presented at ASOPRS 50th Anniversary Fall Scientific Symposium in San Francisco, CA, USA, Oct. 10-11, 2019. * Kyung In Woo [email protected] 1
Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Kangnam-ku, Seoul 06351, South Korea
2
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South K
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