Natural History and Surgical Outcomes of Spheno-Orbital Meningiomas: A Single Centre Experience from Canada.

Abstract

Spheno-orbital meningiomas (SOM) are intracranial tumors arising from the sphenoid wing. Radical resection is anatomically challenging, and the role of adjuvant radiotherapy (RT) for residual disease control remains contentious. Our primary objective is to characterize the natural history, management strategies, and postoperative course of SOM, and to evaluate the impact of adjuvant RT in survival outcomes. Our secondary aim is to identify clinical and imaging predictors of incomplete resection and adjuvant RT use. We retrospectively reviewed patients undergoing craniotomy for SOM between 2001 and 2025 at the Vancouver General Hospital, a large quaternary care academic hospital and level-1 trauma center in British Columbia, Canada. Patients were managed postoperatively with either expectant management (EM) or adjuvant RT (aRT). Kaplan-Meier analyses assessed OS and PFS. Cox regression analyses evaluated predictors of survival while adjusting for extent-of-resection and tumor grade. Ninety-two patients were included (70% female; median age 58 years (IQR: 48, 67), of whom 67 underwent EM and 25 received adjuvant RT. GTR was achieved in 51% of patients managed expectantly (vs. 8% in aRT; p<0.001). Tumors treated with adjuvant RT demonstrated greater vascular encasement (p<0.001), optic apparatus involvement (p=0.004), and CS infiltration (p=0.001). Median OS and PFS were 187.5 and 186.3 months respectively. Five-year PFS was superior with aRT (81% vs. 65%; p=0.027), corresponding to a 7.7-month restricted mean delay in progression over the first 5 years. Multivariable Cox analysis demonstrated adjuvant RT was independently associated with improved PFS (p<0.001). We report outcomes after maximal safe SOM resection and characterize recurrence patterns, supporting the need for long-term surveillance and individualized, multidisciplinary management strategies.