title: Spheno-Orbital Meningiomas: A 16-Year Surgical Experience.
abstract: OBJECTIVE
  To examine the efficacy of spheno-orbital meningioma (SOM) resection aimed at symptomatic improvement, rather than gross total resection, followed by radiation therapy for recurrence.
  
  
  METHODS
  A retrospective review of all patients having undergone resection between 2000 and 2016 was performed. Demographics, operative details, postoperative outcomes, recurrence rates, and radiation treatment plans were analyzed. Statistical analysis was performed to assess for factors affecting recurrence (Fisher exact and Student t test), changes in exophthalmos index (EI) (Student t test), and progression-free survival (Kaplan-Meier and log rank).
  
  
  RESULTS
  Twenty-five patients were included; 92% of participants were women. Mean age was 51 years. World Health Organization grades were I (n = 21) and II (n = 4). Simpson grades were I (n = 14), II (n = 3), and IV (n = 8). Mean follow-up time was 44.8 months. Proptosis was significantly improved at the 3- to 6-month postoperative visit (mean ΔEI, 0.15; P < 0.05) and at last follow-up (mean ΔEI, 0.13; P < 0.05). Visual acuity was either improved or stable in 18 of 19 patients. There were 12 recurrences; mean time to recurrence was 21.8 months. Increased recurrence rate was significantly associated with younger age. Eight patients received fractionated radiation at time of recurrence. To date, all treated patients are progression free.
  
  
  CONCLUSIONS
  Among this cohort, surgery provided a lasting improvement in proptosis and improved or stabilized visual deficits. Surgery followed by radiation at recurrence provided excellent tumor control and lends credence to the growing body of literature demonstrating effective control of subtotally resected skull base meningiomas.
authors.affiliation: Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA. Electronic address: Jacob.freeman@ucdenver.edu.
authors.forename: Jacob L
authors.initials: JL
authors.lastname: Freeman
authors.affiliation: Department of Pediatric Neurology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Davern
authors.affiliation: Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA.
authors.forename: Soliman
authors.initials: S
authors.lastname: Oushy
authors.affiliation: Department of Neurology, University of Colorado, Aurora, Colorado, USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Sillau
authors.affiliation: Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA.
authors.forename: D Ryan
authors.initials: DR
authors.lastname: Ormond
authors.affiliation: Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA.
authors.forename: A Samy
authors.initials: AS
authors.lastname: Youssef
authors.affiliation: Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA.
authors.forename: Kevin O
authors.initials: KO
authors.lastname: Lillehei
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005094:Exophthalmos / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008579:Meningioma / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D019635:Neurosurgical Procedures / Q000379:methods*; D009916:Orbital Diseases / Q000150:complications / Q000628:therapy*; D011183:Postoperative Complications / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery*
keywords: Fractionated radiation; Gross total resection; Spheno-orbital meningioma; Tumor recurrence