A Carrizo

F Ringel

IE Sandalcioglu

J Bonnal

J Rootman

P Saeed

Peerooz Saeed

RK Shrivastava

S Honeybul

VJ Lund

English

PubMed

Saeed, P.

NARCIS 

Surgical management of spheno-orbital meningiomas

Saeed, Peerooz

International Migration, Integration and Social Cohesion online publications

UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl)UvA-DARE (Digital Academic Repository)Surgical management of spheno-orbital meningiomasSaeed, P.DOI10.1007/s00701-011-1038-xPublication date2011Document VersionFinal published versionPublished inActa neurochirurgicaLink to publicationCitation for published version (APA):Saeed, P. (2011). Surgical management of spheno-orbital meningiomas. Actaneurochirurgica, 153(7), 1539-1540. https://doi.org/10.1007/s00701-011-1038-xGeneral rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s)and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an opencontent license (like Creative Commons).Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, pleaselet the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the materialinaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letterto: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. Youwill be contacted as soon as possible.Download date:14 Apr 2023LETTER TO THE EDITORSurgical management of spheno-orbital meningiomasPeerooz SaeedReceived: 15 April 2011 /Accepted: 19 April 2011 /Published online: 7 May 2011# The Author(s) 2011. This article is published with open access at Springerlink.comDear Editor,Dr. Nagatani and colleagues, in their comments on ourstudy of natural history of sphenoid-orbital meningiomas(SOM) [8], have recommended not resecting the portion ofSOM involving cavernous sinus (CS) and superior orbitalfissure (SOF) in order to avoid the risk of permanent cranialnerve dysfunction.As indeed pointed out, the resection of SOMs isassociated with a range of complications.The reported numbers of postoperative neurologicalcomplications after resections of SOMs (primarily cranialnerve palsies) range up to 100% for trigeminal hypesthesias[3, 9], 13% for oculomotor palsy [2, 5, 10], and up to 6%mortality have also been reported [2, 5]. Furthermore, arecurrence rate of up to 50% after a surgical resection hasbeen reported [1].As we have explained in our recent paper on the surgicalresults of SOM [7], given the limited improvement inprognosis and the complications involved in surgery, theaim of surgical treatment for SOM should be restoration ofvisual acuity and reduction of proptosis, rather thancomplete tumor removal.In our group of 66 patients, surgery arrested visualdeterioration or improved visual acuity in 91% of ourpatients. Furthermore, a substantial reduction in proptosiswas achieved in 85% of the patients. Proptosis wasreduced by 2.6±2.6 mm; however, we had hoped toachieve a better result and were disappointed by this levelof improvement [7].To resect SOM, different surgical approaches are used,including transzygomatic, pterional, frontotemporal, combinedtranscranial-transmalar, and cranio-orbital approaches. All ofthese approaches allow sufficient access to the orbit andmiddlefossa base for bony and soft-tissue tumor resection, as well asdecompression of the SOF and optic canal [1–3, 5, 7, 9, 10].The surgical approach can be tailored to the individualcase. Decompression of the optic canal can be achievedthrough a frontotemporal approach combined with orbito-zygomatic (OZ) or a frontotemporal approach alone. Werecommend that the frontotemporal approach combinedwith OZ be reserved for cases that require wide surgicalexposure.Recently, Lund and Rose [4] reported 12 patients withSOM who underwent endoscopic endonasal medialorbital wall decompression and decompression of theoptic canal in eight patients with opticopathy and visualdeterioration. In these patients, the opticopathy improvedand the visual acuity improved by one to four lines onthe Snellen chart.In our view, a craniotomy for debulking is not indicatedfor patients who have mild proptosis or no visualdeterioration. Also, when the major symptom is proptosiswithout optic canal stenosis, an extended lateral orbitotomyalone can be preformed to avoid the complications of acraniotomy. Extended lateral orbitotomy or total lateralorbitotomy has been used routinely for severe cases ofGraves’ orbitopathy and tumors in the orbital apex [6, 7].Because the majority of SOMs are resected sub-totally,radiotherapy should be considered as an adjuvant treatmentfor SOM, as postoperative radiotherapy might give a bettercontrol of tumor growth, with minor side effects.When there is an extension of SOM to CS, we do notrecommend a surgical intervention of that portion of tumor,and radiotherapy should be considered. However, theP. Saeed (*)Orbital Center, Academic Medical Center,University of Amsterdam,P.O. Box 22660, 1100 DD Amsterdam, The Netherlandse-mail: p.saeed@amc.uva.nlActa Neurochir (2011) 153:1539–1540DOI 10.1007/s00701-011-1038-xhyperostotic bone around SOF can be excised safely, withoutdamaging cranial nerves. In conclusion, like Dr. Nagatani andcolleagues, we recommend in the surgical resection of SOM asymptom orientated approach as opposed to a radicalresection, as extensive surgical resection can be associatedwith significant postsurgical morbidity.Conflicts of interest None.Open Access This article is distributed under the terms of the CreativeCommons Attribution Noncommercial License which permits anynoncommercial use, distribution, and reproduction in any medium,provided the original author(s) and source are credited.References1. Bonnal J, Thibaut A, Brotchi J, Born J (1980) Invadingmeningiomas of the sphenoid ridge. J Neurosurg 53:587–5992. Carrizo A, Basso A (1998) Current surgical treatment forsphenoorbital meningiomas. Surg Neuro l50:574–5783. Honeybul S, Neil-Dwyer G, Lang DA, Evans BT, Ellison DW(2001) Sphenoid wing meningioma en plaque: a clinical review.Acta Neurochir (Wien) 143:749–7574. Lund VJ, Rose GE (2006) Endoscopic transnasal orbitaldecompression for visual failure due to sphenoid wing meningioma.Eye (Lond) 20:1213–12195. Ringel F, Cedzich C, Schramm J (2007) Microsurgical techniqueand results of a series of 63 spheno-orbital meningiomas.Neurosurgery 60:214–2216. Rootman J, Stewart B, Goldberg RA (1995) Orbital surgery: aconceptual approach. Lippincott-Raven, Philadelphia7. Saeed P, van Furth WR, Tanck M, Freling N, van der SprenkelJW, Stalpers LJ, van Overbeeke JJ, Mourits MP (2011) Surgicaltreatment of sphenoorbital meningiomas. Br J Ophthalmol.doi:10.1136/bjo.2010.1890508. Saeed P, van Furth WR, Tanck M, Kooremans F, Freling N,Streekstra GI, Regensburg NI, van der Sprenkel JW, PeerdemanSM, van Overbeeke JJ, Mourits MP (2011) Natural history ofspheno-orbital meningiomas. Acta Neurochir (Wien) 153:395–4029. Sandalcioglu IE, Gasser T, Mohr C, Stolke D, Wiedemayer H(2005) Spheno-orbital meningiomas: interdisciplinary surgicalapproach, resectability and long-term results. J CraniomaxillofacSurg 33:260–26610. Shrivastava RK, Sen C, Costantino PD, Della RR (2005)Sphenoorbital meningiomas: surgical limitations and lessonslearned in their long-term management. J Neurosurg 103:491–4971540 Acta Neurochir (2011) 153:1539–1540

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LETTER TO THE EDITOR
Surgical management of spheno-orbital meningiomas
Peerooz Saeed
Received: 15 April 2011 /Accepted: 19 April 2011 /Published online: 7 May 2011
# The Author(s) 2011. This article is published with open access at Springerlink.com
Dear Editor,
Dr. Nagatani and colleagues, in their comments on our
study of natural history of sphenoid-orbital meningiomas
(SOM) [8], have recommended not resecting the portion of
SOM involving cavernous sinus (CS) and superior orbital
fissure (SOF) in order to avoid the risk of permanent cranial
nerve dysfunction.
As indeed pointed out, the resection of SOMs is
associated with a range of complications.
The reported numbers of postoperative neurological
complications after resections of SOMs (primarily cranial
nerve palsies) range up to 100% for trigeminal hypesthesias
[3, 9], 13% for oculomotor palsy [2, 5, 10], and up to 6%
mortality have also been reported [2, 5]. Furthermore, a
recurrence rate of up to 50% after a surgical resection has
been reported [1].
As we have explained in our recent paper on the surgical
results of SOM [7], given the limited improvement in
prognosis and the complications involved in surgery, the
aim of surgical treatment for SOM should be restoration of
visual acuity and reduction of proptosis, rather than
complete tumor removal.
In our group of 66 patients, surgery arrested visual
deterioration or improved visual acuity in 91% of our
patients. Furthermore, a substantial reduction in proptosis
was achieved in 85% of the patients. Proptosis was
reduced by 2.6±2.6 mm; however, we had hoped to
achieve a better result and were disappointed by this level
of improvement [7].
To resect SOM, different surgical approaches are used,
including transzygomatic, pterional, frontotemporal, combined
transcranial-transmalar, and cranio-orbital approaches. All of
these approaches allow sufficient access to the orbit andmiddle
fossa base for bony and soft-tissue tumor resection, as well as
decompression of the SOF and optic canal [1–3, 5, 7, 9, 10].
The surgical approach can be tailored to the individual
case. Decompression of the optic canal can be achieved
through a frontotemporal approach combined with orbito-
zygomatic (OZ) or a frontotemporal approach alone. We
recommend that the frontotemporal approach combined
with OZ be reserved for cases that require wide surgical
exposure.
Recently, Lund and Rose [4] reported 12 patients with
SOM who underwent endoscopic endonasal medial
orbital wall decompression and decompression of the
optic canal in eight patients with opticopathy and visual
deterioration. In these patients, the opticopathy improved
and the visual acuity improved by one to four lines on
the Snellen chart.
In our view, a craniotomy for debulking is not indicated
for patients who have mild proptosis or no visual
deterioration. Also, when the major symptom is proptosis
without optic canal stenosis, an extended lateral orbitotomy
alone can be preformed to avoid the complications of a
craniotomy. Extended lateral orbitotomy or total lateral
orbitotomy has been used routinely for severe cases of
Graves’ orbitopathy and tumors in the orbital apex [6, 7].
Because the majority of SOMs are resected sub-totally,
radiotherapy should be considered as an adjuvant treatment
for SOM, as postoperative radiotherapy might give a better
control of tumor growth, with minor side effects.
When there is an extension of SOM to CS, we do not
recommend a surgical intervention of that portion of tumor,
and radiotherapy should be considered. However, the
P. Saeed (*)
Orbital Center, Academic Medical Center,
University of Amsterdam,
P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
e-mail: p.saeed@amc.uva.nl
Acta Neurochir (2011) 153:1539–1540
DOI 10.1007/s00701-011-1038-x
hyperostotic bone around SOF can be excised safely, without
damaging cranial nerves. In conclusion, like Dr. Nagatani and
colleagues, we recommend in the surgical resection of SOM a
symptom orientated approach as opposed to a radical
resection, as extensive surgical resection can be associated
with significant postsurgical morbidity.
Conflicts of interest None.
Open Access This article is distributed under the terms of the Creative
Commons Attribution Noncommercial License which permits any
noncommercial use, distribution, and reproduction in any medium,
provided the original author(s) and source are credited.
References
1. Bonnal J, Thibaut A, Brotchi J, Born J (1980) Invading
meningiomas of the sphenoid ridge. J Neurosurg 53:587–599
2. Carrizo A, Basso A (1998) Current surgical treatment for
sphenoorbital meningiomas. Surg Neuro l50:574–578
3. Honeybul S, Neil-Dwyer G, Lang DA, Evans BT, Ellison DW
(2001) Sphenoid wing meningioma en plaque: a clinical review.
Acta Neurochir (Wien) 143:749–757
4. Lund VJ, Rose GE (2006) Endoscopic transnasal orbital
decompression for visual failure due to sphenoid wing meningioma.
Eye (Lond) 20:1213–1219
5. Ringel F, Cedzich C, Schramm J (2007) Microsurgical technique
and results of a series of 63 spheno-orbital meningiomas.
Neurosurgery 60:214–221
6. Rootman J, Stewart B, Goldberg RA (1995) Orbital surgery: a
conceptual approach. Lippincott-Raven, Philadelphia
7. Saeed P, van Furth WR, Tanck M, Freling N, van der Sprenkel
JW, Stalpers LJ, van Overbeeke JJ, Mourits MP (2011) Surgical
treatment of sphenoorbital meningiomas. Br J Ophthalmol.
doi:10.1136/bjo.2010.189050
8. Saeed P, van Furth WR, Tanck M, Kooremans F, Freling N,
Streekstra GI, Regensburg NI, van der Sprenkel JW, Peerdeman
SM, van Overbeeke JJ, Mourits MP (2011) Natural history of
spheno-orbital meningiomas. Acta Neurochir (Wien) 153:395–402
9. Sandalcioglu IE, Gasser T, Mohr C, Stolke D, Wiedemayer H
(2005) Spheno-orbital meningiomas: interdisciplinary surgical
approach, resectability and long-term results. J Craniomaxillofac
Surg 33:260–266
10. Shrivastava RK, Sen C, Costantino PD, Della RR (2005)
Sphenoorbital meningiomas: surgical limitations and lessons
learned in their long-term management. J Neurosurg 103:491–497
1540 Acta Neurochir (2011) 153:1539–1540


Crossref

Acta Neurochirurgica

UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl)UvA-DARE (Digital Academic Repository)Surgical management of spheno-orbital meningiomasSaeed, P.DOI10.1007/s00701-011-1038-xPublication date2011Document VersionFinal published versionPublished inActa neurochirurgicaLink to publicationCitation for published version (APA):Saeed, P. (2011). Surgical management of spheno-orbital meningiomas. Actaneurochirurgica, 153(7), 1539-1540. https://doi.org/10.1007/s00701-011-1038-xGeneral rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s)and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an opencontent license (like Creative Commons).Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, pleaselet the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the materialinaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letterto: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. Youwill be contacted as soon as possible.Download date:09 Mar 2023LETTER TO THE EDITORSurgical management of spheno-orbital meningiomasPeerooz SaeedReceived: 15 April 2011 /Accepted: 19 April 2011 /Published online: 7 May 2011# The Author(s) 2011. This article is published with open access at Springerlink.comDear Editor,Dr. Nagatani and colleagues, in their comments on ourstudy of natural history of sphenoid-orbital meningiomas(SOM) [8], have recommended not resecting the portion ofSOM involving cavernous sinus (CS) and superior orbitalfissure (SOF) in order to avoid the risk of permanent cranialnerve dysfunction.As indeed pointed out, the resection of SOMs isassociated with a range of complications.The reported numbers of postoperative neurologicalcomplications after resections of SOMs (primarily cranialnerve palsies) range up to 100% for trigeminal hypesthesias[3, 9], 13% for oculomotor palsy [2, 5, 10], and up to 6%mortality have also been reported [2, 5]. Furthermore, arecurrence rate of up to 50% after a surgical resection hasbeen reported [1].As we have explained in our recent paper on the surgicalresults of SOM [7], given the limited improvement inprognosis and the complications involved in surgery, theaim of surgical treatment for SOM should be restoration ofvisual acuity and reduction of proptosis, rather thancomplete tumor removal.In our group of 66 patients, surgery arrested visualdeterioration or improved visual acuity in 91% of ourpatients. Furthermore, a substantial reduction in proptosiswas achieved in 85% of the patients. Proptosis wasreduced by 2.6±2.6 mm; however, we had hoped toachieve a better result and were disappointed by this levelof improvement [7].To resect SOM, different surgical approaches are used,including transzygomatic, pterional, frontotemporal, combinedtranscranial-transmalar, and cranio-orbital approaches. All ofthese approaches allow sufficient access to the orbit andmiddlefossa base for bony and soft-tissue tumor resection, as well asdecompression of the SOF and optic canal [1–3, 5, 7, 9, 10].The surgical approach can be tailored to the individualcase. Decompression of the optic canal can be achievedthrough a frontotemporal approach combined with orbito-zygomatic (OZ) or a frontotemporal approach alone. Werecommend that the frontotemporal approach combinedwith OZ be reserved for cases that require wide surgicalexposure.Recently, Lund and Rose [4] reported 12 patients withSOM who underwent endoscopic endonasal medialorbital wall decompression and decompression of theoptic canal in eight patients with opticopathy and visualdeterioration. In these patients, the opticopathy improvedand the visual acuity improved by one to four lines onthe Snellen chart.In our view, a craniotomy for debulking is not indicatedfor patients who have mild proptosis or no visualdeterioration. Also, when the major symptom is proptosiswithout optic canal stenosis, an extended lateral orbitotomyalone can be preformed to avoid the complications of acraniotomy. Extended lateral orbitotomy or total lateralorbitotomy has been used routinely for severe cases ofGraves’ orbitopathy and tumors in the orbital apex [6, 7].Because the majority of SOMs are resected sub-totally,radiotherapy should be considered as an adjuvant treatmentfor SOM, as postoperative radiotherapy might give a bettercontrol of tumor growth, with minor side effects.When there is an extension of SOM to CS, we do notrecommend a surgical intervention of that portion of tumor,and radiotherapy should be considered. However, theP. Saeed (*)Orbital Center, Academic Medical Center,University of Amsterdam,P.O. Box 22660, 1100 DD Amsterdam, The Netherlandse-mail: p.saeed@amc.uva.nlActa Neurochir (2011) 153:1539–1540DOI 10.1007/s00701-011-1038-xhyperostotic bone around SOF can be excised safely, withoutdamaging cranial nerves. In conclusion, like Dr. Nagatani andcolleagues, we recommend in the surgical resection of SOM asymptom orientated approach as opposed to a radicalresection, as extensive surgical resection can be associatedwith significant postsurgical morbidity.Conflicts of interest None.Open Access This article is distributed under the terms of the CreativeCommons Attribution Noncommercial License which permits anynoncommercial use, distribution, and reproduction in any medium,provided the original author(s) and source are credited.References1. Bonnal J, Thibaut A, Brotchi J, Born J (1980) Invadingmeningiomas of the sphenoid ridge. J Neurosurg 53:587–5992. Carrizo A, Basso A (1998) Current surgical treatment forsphenoorbital meningiomas. Surg Neuro l50:574–5783. Honeybul S, Neil-Dwyer G, Lang DA, Evans BT, Ellison DW(2001) Sphenoid wing meningioma en plaque: a clinical review.Acta Neurochir (Wien) 143:749–7574. Lund VJ, Rose GE (2006) Endoscopic transnasal orbitaldecompression for visual failure due to sphenoid wing meningioma.Eye (Lond) 20:1213–12195. Ringel F, Cedzich C, Schramm J (2007) Microsurgical techniqueand results of a series of 63 spheno-orbital meningiomas.Neurosurgery 60:214–2216. Rootman J, Stewart B, Goldberg RA (1995) Orbital surgery: aconceptual approach. Lippincott-Raven, Philadelphia7. Saeed P, van Furth WR, Tanck M, Freling N, van der SprenkelJW, Stalpers LJ, van Overbeeke JJ, Mourits MP (2011) Surgicaltreatment of sphenoorbital meningiomas. Br J Ophthalmol.doi:10.1136/bjo.2010.1890508. Saeed P, van Furth WR, Tanck M, Kooremans F, Freling N,Streekstra GI, Regensburg NI, van der Sprenkel JW, PeerdemanSM, van Overbeeke JJ, Mourits MP (2011) Natural history ofspheno-orbital meningiomas. Acta Neurochir (Wien) 153:395–4029. Sandalcioglu IE, Gasser T, Mohr C, Stolke D, Wiedemayer H(2005) Spheno-orbital meningiomas: interdisciplinary surgicalapproach, resectability and long-term results. J CraniomaxillofacSurg 33:260–26610. Shrivastava RK, Sen C, Costantino PD, Della RR (2005)Sphenoorbital meningiomas: surgical limitations and lessonslearned in their long-term management. J Neurosurg 103:491–4971540 Acta Neurochir (2011) 153:1539–1540

UvA-DARE

Basso A

Endoscopic transnasal orbital decompression for visual failure due to sphenoid wing meningioma. Eye (Lond)

Invading meningiomas of the sphenoid ridge.

Microsurgical technique and results of a series of 63 spheno-orbital meningiomas.

Natural history of spheno-orbital meningiomas. Acta Neurochir

Orbital surgery: a conceptual approach. Lippincott-Raven,

Spheno-orbital meningiomas: interdisciplinary surgical approach, resectability and long-term results.

Sphenoid wing meningioma en plaque: a clinical review. Acta Neurochir

Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management.

Surgical treatment of sphenoorbital meningiomas.

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Surgical management of spheno-orbital meningiomas

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