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

Background: Spheno-orbital meningiomas en plaque are located in a complex area between the orbital and intracranial compartments and characterized by carpet like growth that infiltrate the dura mater and surrounding bone. Objective: This retrospective study analyzes the postoperative clinical and radiological outcome of twenty three patients with spheno orbital meningiomas en plaque operated upon in the Neurosurgery Department, Cairo University Hospitals. Patients and Methods: Patient selection: patients with spheno orbital meningiomas en plaque. Operation: surgical resection of the tumor, involved bones and periorbita via fronto-temporal approach. Results: Between Jan 2010 and December 2013, twenty three patients were operated upon for treating spheno-orbital meningiomas en plaque via fronto-temporal approach and followed up clinically and radiologically for a mean of 18 months. During clinical follow up, improvement of proptosis was achieved in fifteen patients (78.9%) out of nineteen patients presented with proptosis at a mean of 2 months postoperatively, visual improvement occurred in seven patients (58.3%) out of twelve patients presented with decreased visual acuity within the postoperative 2-12 weeks. Postoperatively, lid and orbital swelling occurred in all patients (100%), cranial nerve palsy in ten patients in which seven were transient (30.4%) and three were permanent (13%), subgaleal CSF collection occurred in eleven patients (47.8%), intra cerebral hematoma in one patients (4.4%) and two patients (8.7%) developed postoperative fits. Radiological follow up revealed total resection in sixteen patients (69.6%) and no recurrence was encountered. Conclusion: Spheno-orbital meningiomas en plaque are located in a complex anatomical region. Surgical management is not uniform and should be tailored to fit each case. Radical tumor excision can be achieved by proper microsurgical dissection, aggressive bony removal and wide orbital decompression with low postoperative morbidity, good clinical outcome and less rate of recurrence. However, greater sample size and longer follow up would aid further documentation.