[Long-term results of the surgical treatment of spheno-orbital osteomeningioma].

The authors report a series of 21 cases of spheno-orbital "en plaque" meningiomas operated on between 1981 and 1993. All patients underwent surgery via fronto-temporal approach with orbito-zygomatic removal, followed by bone reconstruction. A complete tumor resection was performed in 15 cases. In the remaining patients, tumor resection remained subtotal, as the cavernous sinus was involved. Histological examination 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 incomplete or for high grade meningiomas. The mean follow up was 7 years. One patient died in the post-operative course. Transient ophthalmoparesis occurred in 9 cases, 2 patients had pre-operative oculomotor palsy related to tumoral extension in the cavernous sinus and remained unchanged. Visual acuity remained unchanged after surgery in all patients who presented with normal visual acuity. It was unchanged or improved in 63% of patients who presented with 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 necessary to complete the resection of the tumor extended in the orbit, the orbital fissures or the optic canal. Early operation allows a complete tumor resection before the tumor extends to the cavernous sinus.