Visual outcomes endorse surgery of patients with spheno-orbital meningioma with minimal visual impairment or hyperostosi
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ORIGINAL ARTICLE - TUMOR - MENINGIOMA
Visual outcomes endorse surgery of patients with spheno-orbital meningioma with minimal visual impairment or hyperostosis Amir H. Zamanipoor Najafabadi 1
&
Stijn W. Genders 2,3 & Wouter R. van Furth 1
Received: 5 July 2020 / Accepted: 24 August 2020 # The Author(s) 2020
Abtract Background Most spheno-orbital meningioma series span multiple decades, and predictors of visual outcomes have not yet been systemically assessed. We describe visual outcomes in a recent cohort and assess predictors of postoperative visual outcomes. Methods Consecutive case series operated by a team of a neurosurgeon and orbital surgeon between May 2015 and January 2019. Best corrected visual acuity (BCVA), visual fields (static perimetry), and relative proptosis were measured preoperatively and postoperatively at 3/6/12 months after which it was assessed yearly. Predictors were assessed with linear regression analysis. Results Nineteen patients (all WHO grade I) were operated by the pterional approach (median follow-up 2.4 years). Preoperative visual acuity deficits (n = 10) normalized in 70% and improved in 10% (median preoperative: 0.8, postoperative: 1.2, p = 0.021). Preoperative visual field deficits (n = 8) normalized in all patients (preoperative: − 6.5 dB, postoperative: − 1.5 dB, p = 0.008). Preoperative proptosis (n = 16) normalized in 44% and improved in 56% (preoperative: 5 mm, postoperative: 2 mm, p < 0.001). BCVA and visual fields remained stable at longer follow-up in 95% of patients, while 21% showed progression of proptosis. Predictors for worse longer-term (> 12 months) BCVA were worse preoperative BCVA (p = 0.002) and diagnosis of multiple meningioma (p = 0.021). Predictors for worse longer-term visual fields were higher diameter of hyperostosis (p = 0.009) and higher Simpson grade (p = 0.032). Predictor for short-term (3 months) proptosis was preoperative proptosis (p = 0.006). Conclusion We recommend surgery, even of patients with minimal visual impairment or hyperostosis, as patients who present with deteriorated visual function or extensive hyperostosis are less likely to have postoperative visual outcomes restored to normal. Keywords Spheno-orbital . Meningioma . Surgery . Vision . Hyperostosis This article is part of the Topical Collection on Tumor - Meningioma Previous presentations Parts of the results described in this manuscript were presented at the 13th Congress of the European Skull Base Society in 2018 in Warsaw, Poland. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04554-9) contains supplementary material, which is available to authorized users. * Amir H. Zamanipoor Najafabadi [email protected] 1
University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
2
Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
3
Orbital Center, Department of Ophthalmology, Amsterdam Univ
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