SPHENO-ORBITAL EN PLAQUE MENINGIOMAS - LO NG-TERM RESULTS OF SURGERY

The authors report a series of 21 cases of spheno-orbital << en plaque >> meningiomas operated on between 1981 and 1993. All patients underw ent surgery via fronto-temporal approach with orbite-zygomatic removal , followed by bone reconstruction. A complete tumor resection was perf ormed in 15 cases. In the remaining patients, tumor resection remained subtotal, as the cavernous sinus was involved. Histological examinati on disclosed a low grade meningioma in 17 cases, high grade meningioma in the other patients. Radiation therapy was performed in 5 patients, when the tumoral resection was uncomplete or for high grade meningiom as. The mean follow up was 7 years. One patient died in the post-opera tive course. Transient ophtalmoparesis occured in 9 cases, 2 patients had pre-operative oculomotor palsy related to tumoral extension in the cavernous sinus and remained unchanged. Visual acuity remained unchan ged after surgery in all patients who presented with normal visual acu ity. It was unchanged or improved in 63% of patients who presented wit h moderate visual impairment. Despite the extent of the bone resection , the cosmetic results were good or excellent in 75% of patients, fair in 17%, and bad in 8%. Recurrence of the tumor occurred in 3 patients , with high-grade meningiomas (2 cases) or after subtotal removal of a low-grade meningioma (1 case). Orbito-fronto-temporal approach is nec essary to complete the resection of the tumor extended in the orbit, t he orbital fissures or the optic canal. Early operation allows a compl ete tumor resection before the tumor extends to the cavernous sinus.