P13.06.A SPHENO-ORBITAL MENINGIOMAS - PROGNOSTIC FACTORS FOR PROPTOSIS NORMALIZATION

Abstract BACKGROUND Spheno-orbital meningiomas (SOMs) are a unique and complex subgroup of skull base meningiomas. They are characterized by significant hyperostosis of the sphenoid wing and an intradural soft tissue component. Involvement of the orbital compartment causes typical compressive clinical symptoms (proptosis and visual impairment). Gross total resection (GTR) is usually still the primary goal of treatment. So far, there is no consensus in the literature regarding the benefits of GTR or the positive prognostic factors associated with the improvement of proptosis and visual function. The aim of our study was to identify favorable prognostic factors associated with the improvement of proptosis and visual function and to assess the risk-benefit of radical resection. MATERIAL AND METHODS A retrospective single-center review of thirty-five patients who underwent surgery for SOMs between 2000 and 2024 was performed. Preoperative symptoms, surgical, visual, and proptosis outcomes, along with complications, were evaluated. Potential favorable prognostic factors associated with the improvement of proptosis and visual function, as well as the risks of radical surgery, were analyzed statistically. RESULTS All patients underwent surgery through a frontotemporal craniotomy. GTR was achieved in 40%, while subtotal resection (STR) was performed in 60% of cases. Among the 26 patients who had preoperative proptosis, postoperative improvement was observed in 24 (92%). Out of 20 patients with a preoperative visual deficit, 14 (70%) experienced postoperative improvement. A symptom duration of less than 6 months (p = 0.002), opening/resection of the periorbit (p = 0.0014), and GTR (p = 0.009) were statistically significant factors associated with postoperative normalization of proptosis. No statistically significant factor was detected for improvement in vision. GTR was significantly associated with surgical morbidity (p < 0.001). CONCLUSION Surgery for SOMs is a therapeutic challenge. Early GTR, including opening/resection of the periorbit, is associated with proptosis normalization. However, GTR is accompanied by increased surgical morbidity. This study was funded by the grant of Ministry of Health of the Czech Republic - Conceptual Development of Research Organization (Faculty Hospital in Pilsen - FNPl, 00669806)