Abstract Date: 5/2/2015
William T. Couldwell, MD, PhD
Christian Bowers, MD (Salt Lake City, UT)
Proptosis associated with sphenoorbital and other skull base meningiomas can be cosmetically and functionally problematic; however, the literature is limited regarding quantitative proptosis outcomes with no consensus regarding the optimal surgical technique. We evaluated proptosis outcomes to determine whether an aggressive surgical removal of the periorbita in addition to bone involvement yielded better improvement and whether this was associated with additional morbidity. No attempt was made to reconstruct the orbit.
The authors reviewed a retrospective cohort of surgeries for meningioma-associated proptosis by a single surgeon. The extent of proptosis resolution was measured by the exophthalmos index (EI) pre- and postoperatively and at final follow-up.
Thirty-two patients (19 female; mean age 49 years) were treated for meningioma-associated proptosis. Twenty had additional visual symptoms, such as a loss of visual acuity, a field cut, or diplopia. None of the patients had worse vision after treatment: 15 had improved vision and 5 had stable vision (average follow-up 33.0 months). Diplopia was present postoperatively but resolved in all cases. No cases of enophthalmos were noted. The average preoperative EI was 1.33, and the average EI at most recent follow-up was 1.01, yielding an average EI improvement of 0.32. One case of delayed vasospasm was noted. One patient experienced recurrence of hyperostosis within the treatment zone, which was managed by repeat surgery and postoperative radiation therapy.
Experience from this series indicates that aggressive tumor removal involving the periorbita in cases of meningioma-associated proptosis achieves enhanced cosmetic outcome.
Article ID: AA-31560