Multidisciplinary treatment strategy optimization and long-term prognosis in spheno-orbital meningiomas: a multicenter retrospective study.

BACKGROUND

Spheno-orbital meningiomas which includes en plaque sphenoid wing meningiomas are rare skull base tumors. Current treatment approaches include neurosurgical resection, stereotactic radiotherapy (SRT), observational follow-up, and combined modalities such as maximal safe resection with adjuvant radiotherapy/radiosurgery.

OBJECTIVES

The aim of this study was to systematically evaluate the efficacy of multidisciplinary treatment strategies, compare visual preservation and tumor control rates among different therapeutic modalities, and emphasize combined treatment paradigms for invasive cases.

METHODS

A multicenter retrospective study was conducted with spheno-orbital meningioma patients from January 2010-December 2021 across 3 tertiary medical centers. Patients were stratified into four groups based on initial treatment: neurosurgical resection alone, SRT alone, observational follow-up, and combined treatment such as maximal safe resection with adjuvant RT/SRS for residual tumor. Tumor subtypes were classified by anatomical involvement such as intracranial-only, hyperostosis/bone invasion, and intraorbital extension. Primary endpoints were visual function preservation and tumor control rate. Secondary endpoints included overall survival, progression-free survival (PFS), and treatment-related complications. Propensity score matching (PSM) balanced baseline confounding factors, and histological grade was incorporated into survival analyses.

RESULTS

A total of 426 patients were included in the study and the comprised of resection alone: 218, SRT alone: 123, observation: 85, combined treatment: 47 with a median follow-up of 48 months. The resection group showed significantly higher stable/improved visual function (78.4%) compared to the SRT group (65.1%) and observation group (42.3%, p = 0.003). The combined treatment subgroup achieved an 89.4% 5-year tumor control rate and 76.6% visual preservation rate, outperforming resection alone with 88.9% tumor control, 78.4% visual preservation and SRT alone with 82.5% tumor control, 65.1% visual preservation in invasive cases.

CONCLUSIONS

Multidisciplinary treatment tailored to patient-specific characteristics such as tumor location, age, volume, histological grade, and invasiveness improves outcomes in spheno-orbital meningiomas.