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Anjulie K Quick, Alina Valentina Dumitrescu, Jason Sokol, Thomas Whittaker, Roukoz B Chamoun, Paul J Camarata; A 4-year retrospective chart review of sphenoid wing meningiomas. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4752.
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© ARVO (1962-2015); The Authors (2016-present)
Sphenoid wing meningiomas (SWM) are benign invasive tumors that can cause significant ocular morbitity. The aim of this study was to determine the demographics, clinical exam and imaging findings, and post operative outcomes in our population of patients.
A retrospective, descriptive, chart review was performed after IRB approval. All biopsied/surgically removed orbital lesions treated in our department between 2010 and 2014 were identified by surgical CPT codes. Those patients with SWM were then identified. In each case gender and age of the patients, pathological diagnosis, and laterality were registered.
Out of 141 patients identified during chart review, 8 patients met criteria for SWM over a 4-year period. There was a predominance of female patients (87%) and average age at the time of diagnosis was 55. Patients presented with proptosis (4), visual loss (2), jaw pain (1), and subdural hematoma (1). 75% of patients presented with visual acuity 20/25 or better. Major clinical findings included afferent pupillary defect (6), average of 3.5 mm increase in proptosis, ophthalmoplegia (4), and diplopia (4). 87% of patients had formal visual fields and of those, 85% had an inferior field defect. Post resection, two of the patients who had repeat visual fields showed similar defects as before surgery. Computed tomography (CT) and magnetic resonance imaging (MRI) were the imaging of choice in all patients. 62% were correctly identified as SWM by radiologist on MRI. Imaging findings consistent with SWM included hyperostosis, homogenous enhancing mass, and osseous involvement. All tumors were removed by an oculoplastics surgeon with an orbitozygomatic approach with collaboration from neurosurgery. Diagnosis was confirmed by pathology report. Post-operatively, 62% of patients experienced ptosis and in all patients visual acuity improved or remained the same.
SWM present a unique situation that combines the efforts of ophthalmology and neurosurgery. An ophthalmologist may be the first person to recognize the tumor as the majority of patients present with ocular complaints. Although those with compressive optic neuropathy from SWM maintain good vision they can still have residual pupillary defects and visual field loss. An orbitozygomatic surgical approach is a safe and effective method for removal of SWM. Future research involves exploring genetic and pathologic markers.
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