{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T15:30:37Z","timestamp":1772724637146,"version":"3.50.1"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Resection is the foundation of spheno-orbital meningioma (SOM) treatment, but the confluence of critical neurovascular structures traversing the cranium and orbit and the unforgiving nature of orbital injury make resection of the tumor\u2019s orbital components challenging. Large series detailing surgical outcomes are rarely reported, and a surgical framework is needed. This study examined the feasibility of resection of SOMs with an involved orbit. The authors classified SOMs based on the relative orbital involvement to determine tumor resectability, with the goals of improving proptosis and functional visual outcome and avoiding new deficit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective chart review identified patients with surgically treated SOMs with a minimum 1-year follow-up at an academic center from 2002 to 2023. Imaging and clinical presentations and outcomes are reported, and a clinically relevant grading system is proposed based on imaging findings of orbital hyperostosis (grade 1), periorbital involvement (grade 2), intraorbital involvement without (grade 3a) or with (grade 3b) rectus muscle invasion, or involvement of the orbital apex or optic nerve (grade 4).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 93 included patients (71% female), the mean age at surgery was 54.8 years. The most common presentations were proptosis (74.2%), visual decline (57.0%), and cranial neuropathies (30.1%). Gross-total resection of the orbital contents was achieved in 88.5%, 50.0%, 16.7%, and 24.1% of grade 1\u20134 tumors, respectively; it was less likely in grade 3 or 4 tumors (OR 0.06, 95% CI 0.019\u20130.190; p &lt; 0.001), unless it was for oncological removal in a patient with no functional vision. Resection led to stable or improved vision in most patients across all grades (96.2%, 100%, 83.3%, and 93.1% in grade 1\u20134 tumors, respectively). Proptosis was less pronounced in grade 1 tumors, and the degree of proptosis was statistically more likely to improve with pronounced proptosis in higher-grade tumors (\u0394exophthalmos index 0.04, 0.14, 0.11, and 0.15 in grade 1\u20134 tumors, respectively). Overall surgical, visual, and ophthalmological morbidities were similar across all grades, and there were no deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This study introduces a grading system for SOMs and validates its utility through the assessment of surgical outcomes of a large patient cohort. This grading system allows for a better understanding of visual risks associated with surgery and facilitates comparisons across clinical studies. This may guide clinical management discussions and future research of this complex pathology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.7.jns242730","type":"journal-article","created":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T01:40:42Z","timestamp":1761961242000},"page":"336-345","source":"Crossref","is-referenced-by-count":1,"title":["Resectability of spheno-orbital meningiomas: surgical outcome in 93 cases and a proposed clinically relevant anatomical classification"],"prefix":"10.3171","volume":"144","author":[{"given":"William T.","family":"Couldwell","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farshad","family":"Nassiri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cameron","family":"Rawanduzy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyril","family":"Cole","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashish Kumar","family":"Jha","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"J Neurosurg","first-page":"711","article-title":"Hyperostosing sphenoid wing meningiomas: surgical outcomes and strategy for bone resection and multidisciplinary orbital reconstruction","volume":"134","author":"Dalle Ore CL","year":"2021","unstructured":"Dalle Ore CL, Magill ST, Rodriguez Rubio R,  Hyperostosing sphenoid wing meningiomas: surgical outcomes and strategy for bone resection and multidisciplinary orbital reconstruction. J Neurosurg. 2021;134(3):711\u2013720."},{"key":"b2","first-page":"e145","article-title":"Spheno-orbital meningiomas surgery: multicenter management study for complex extensive tumors","volume":"112","author":"Terrier LM","year":"2018","unstructured":"Terrier LM, Bernard F, Fournier HD,  Spheno-orbital meningiomas surgery: multicenter management study for complex extensive tumors. World Neurosurg.2018;112:e145\u2013e156."},{"issue":"2","key":"b3","series-title":"J Neurol Surg B Skull Base","first-page":"145","article-title":"The role of the transorbital superior eyelid approach in the management of selected spheno-orbital meningiomas: in-depth analysis of indications, technique, and outcomes from the study of a cohort of 35 patients","volume":"83","author":"Locatelli D","year":"2022","unstructured":"Locatelli D, Restelli F, Alfiero T,  The role of the transorbital superior eyelid approach in the management of selected spheno-orbital meningiomas: in-depth analysis of indications, technique, and outcomes from the study of a cohort of 35 patients. J Neurol Surg B Skull Base. 2022;83(2):145\u2013158."},{"issue":"3","key":"b4","series-title":"J Neurosurg","first-page":"491","article-title":"Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management","volume":"103","author":"Shrivastava RK","year":"2005","unstructured":"Shrivastava RK, Sen C, Costantino PD, Della Rocca R. Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management. J Neurosurg. 2005;103(3):491\u2013497."},{"issue":"3","key":"b5","series-title":"J Neurosurg","first-page":"544","article-title":"Outcomes after surgical treatment of meningioma-associated proptosis","volume":"125","author":"Bowers CA","year":"2016","unstructured":"Bowers CA, Sorour M, Patel BC, Couldwell WT. Outcomes after surgical treatment of meningioma-associated proptosis. 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Acta Ophthalmol. 2021;99(1):26\u201336."},{"issue":"11","key":"b8","series-title":"Cancers (Basel)","first-page":"2148","article-title":"Spheno-orbital meningiomas: the rationale behind the decision-making process of treatment strategy","volume":"16","author":"Mariniello G","year":"2024","unstructured":"Mariniello G, Corvino S, Corazzelli G,  Spheno-orbital meningiomas: the rationale behind the decision-making process of treatment strategy. Cancers (Basel). 2024;16(11):2148."},{"issue":"suppl 1","key":"b9","series-title":"Clin Neurosurg","first-page":"45","article-title":"Unilateral exophthalmos","volume":"14","author":"Krayenb\u00fchl HA","year":"1967","unstructured":"Krayenb\u00fchl HA. Unilateral exophthalmos. 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Surg Neurol Int. 2022;13:318."},{"issue":"4 Suppl 2","key":"b12","series-title":"Neurosurgery","first-page":"214","article-title":"Microsurgical technique and results of a series of 63 spheno-orbital meningiomas","volume":"60","author":"Ringel F","year":"2007","unstructured":"Ringel F, Cedzich C, Schramm J. Microsurgical technique and results of a series of 63 spheno-orbital meningiomas. Neurosurgery. 2007;60(4 Suppl 2):214\u2013222."},{"issue":"5","key":"b13","series-title":"Clinical article. J Neurosurg","first-page":"1069","article-title":"Long-term results with exophthalmos in a surgical series of 30 sphenoorbital meningiomas","volume":"111","author":"Scarone P","year":"2009","unstructured":"Scarone P, Leclerq D, H\u00e9ran F, Robert G. Long-term results with exophthalmos in a surgical series of 30 sphenoorbital meningiomas. Clinical article. J Neurosurg. 2009;111(5):1069\u20131077."},{"issue":"6 Suppl","key":"b14","series-title":"Neurosurgery","first-page":"100","article-title":"En plaque sphenoid wing meningiomas: recurrence factors and surgical strategy in a series of 71 patients","volume":"65","author":"Mirone G","year":"2009","unstructured":"Mirone G, Chibbaro S, Schiabello L, Tola S, George B. En plaque sphenoid wing meningiomas: recurrence factors and surgical strategy in a series of 71 patients. Neurosurgery. 2009;65(6 Suppl):100\u2013109."},{"issue":"18","key":"b15","series-title":"J Clin Med","first-page":"5840","article-title":"Surgical treatment of spheno-orbital meningiomas: a systematic review and meta-analysis of surgical techniques and outcomes","volume":"12","author":"Agosti E","year":"2023","unstructured":"Agosti E, Zeppieri M, De Maria L,  Surgical treatment of spheno-orbital meningiomas: a systematic review and meta-analysis of surgical techniques and outcomes. J Clin Med. 2023;12(18):5840."},{"issue":"2","key":"b16","series-title":"J Neurosurg","first-page":"202","article-title":"Recurrent spheno-orbital meningioma","volume":"80","author":"Maroon JC","year":"1994","unstructured":"Maroon JC, Kennerdell JS, Vidovich DV, Abla A, Sternau L. Recurrent spheno-orbital meningioma. J Neurosurg. 1994;80(2):202\u2013208."},{"key":"b17","first-page":"252","article-title":"Resection of invasive sphenoorbital and cavernous sinus meningioma via frontotemporal craniotomy","volume":"141","author":"Cohen MA","year":"2020","unstructured":"Cohen MA, Cannon RB, Couldwell WT. Resection of invasive sphenoorbital and cavernous sinus meningioma via frontotemporal craniotomy. World Neurosurg.2020;141:252."},{"issue":"7","key":"b18","series-title":"Acta Neurochir (Wien)","first-page":"1539","article-title":"Surgical management of spheno-orbital meningiomas","volume":"153","author":"Nagatani K","year":"2011","unstructured":"Nagatani K, Takeuchi S, Otani N, Nawashiro H. Surgical management of spheno-orbital meningiomas. Acta Neurochir (Wien). 2011;153(7):1539\u20131541."},{"issue":"1","key":"b19","series-title":"Egypt J Neurol Psychiatry Neurosurg","first-page":"18","article-title":"Spheno-orbital meningiomas: surgical techniques and results","volume":"57","author":"Elborady MA","year":"2021","unstructured":"Elborady MA, Nazim WM. Spheno-orbital meningiomas: surgical techniques and results. Egypt J Neurol Psychiatry Neurosurg. 2021;57(1):18."},{"issue":"5","key":"b20","series-title":"J Neurosurg","first-page":"905","article-title":"Management of bone-invasive, hyperostotic sphenoid wing meningiomas","volume":"107","author":"Bikmaz K","year":"2007","unstructured":"Bikmaz K, Mrak R, Al-Mefty O. Management of bone-invasive, hyperostotic sphenoid wing meningiomas. J Neurosurg. 2007;107(5):905\u2013912."},{"issue":"5","key":"b21","series-title":"J Neurosurg","first-page":"1241","article-title":"Sphenoorbital meningioma: surgical technique and outcome","volume":"114","author":"Oya S","year":"2011","unstructured":"Oya S, Sade B, Lee JH. Sphenoorbital meningioma: surgical technique and outcome. J Neurosurg. 2011;114(5):1241\u20131249."},{"issue":"5","key":"b22","series-title":"J Neurosurg","first-page":"1305","article-title":"Orbital reconstruction and volume in the correction of proptosis after resection of spheno-orbital meningiomas","volume":"140","author":"Murayi R","year":"2024","unstructured":"Murayi R, El-Abtah M, Xiao T, Recinos PF, Kshettry VR. Orbital reconstruction and volume in the correction of proptosis after resection of spheno-orbital meningiomas. J Neurosurg. 2024;140(5):1305\u20131311."},{"issue":"1","key":"b23","series-title":"Acta Neurochir (Wien)","first-page":"164","article-title":"Predictive factors of the postoperative proptosis recovery in surgery of spheno-orbital meningiomas","volume":"166","author":"Baucher G","year":"2024","unstructured":"Baucher G, Troude L, Al-Shabibi T, Avinens V, Fernandes S, Roche PH. Predictive factors of the postoperative proptosis recovery in surgery of spheno-orbital meningiomas. Acta Neurochir (Wien). 2024;166(1):164."},{"issue":"3","key":"b24","series-title":"Technical note. J Neurosurg","first-page":"483","article-title":"Cranioplasty with the Medpor porous polyethylene flexblock implant","volume":"81","author":"Couldwell WT","year":"1994","unstructured":"Couldwell WT, Chen TC, Weiss MH, Fukushima T, Dougherty W. Cranioplasty with the Medpor porous polyethylene flexblock implant. Technical note. J Neurosurg. 1994;81(3):483\u2013486."},{"issue":"3","key":"b1","series-title":"J Neurosurg","first-page":"711","article-title":"Hyperostosing sphenoid wing meningiomas: surgical outcomes and strategy for bone resection and multidisciplinary orbital reconstruction","volume":"134","author":"Dalle Ore CL","year":"2021","unstructured":"Dalle Ore CL, Magill ST, Rodriguez Rubio R,  Hyperostosing sphenoid wing meningiomas: surgical outcomes and strategy for bone resection and multidisciplinary orbital reconstruction. J Neurosurg. 2021;134(3):711\u2013720."},{"key":"b2","first-page":"e145","article-title":"Spheno-orbital meningiomas surgery: multicenter management study for complex extensive tumors","volume":"112","author":"Terrier LM","year":"2018","unstructured":"Terrier LM, Bernard F, Fournier HD,  Spheno-orbital meningiomas surgery: multicenter management study for complex extensive tumors. World Neurosurg.2018;112:e145\u2013e156."},{"issue":"2","key":"b3","series-title":"J Neurol Surg B Skull Base","first-page":"145","article-title":"The role of the transorbital superior eyelid approach in the management of selected spheno-orbital meningiomas: in-depth analysis of indications, technique, and outcomes from the study of a cohort of 35 patients","volume":"83","author":"Locatelli D","year":"2022","unstructured":"Locatelli D, Restelli F, Alfiero T,  The role of the transorbital superior eyelid approach in the management of selected spheno-orbital meningiomas: in-depth analysis of indications, technique, and outcomes from the study of a cohort of 35 patients. J Neurol Surg B Skull Base. 2022;83(2):145\u2013158."},{"issue":"3","key":"b4","series-title":"J Neurosurg","first-page":"491","article-title":"Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management","volume":"103","author":"Shrivastava RK","year":"2005","unstructured":"Shrivastava RK, Sen C, Costantino PD, Della Rocca R. Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management. J Neurosurg. 2005;103(3):491\u2013497."},{"issue":"3","key":"b5","series-title":"J Neurosurg","first-page":"544","article-title":"Outcomes after surgical treatment of meningioma-associated proptosis","volume":"125","author":"Bowers CA","year":"2016","unstructured":"Bowers CA, Sorour M, Patel BC, Couldwell WT. Outcomes after surgical treatment of meningioma-associated proptosis. 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Acta Ophthalmol. 2021;99(1):26\u201336."},{"issue":"11","key":"b8","series-title":"Cancers (Basel)","first-page":"2148","article-title":"Spheno-orbital meningiomas: the rationale behind the decision-making process of treatment strategy","volume":"16","author":"Mariniello G","year":"2024","unstructured":"Mariniello G, Corvino S, Corazzelli G,  Spheno-orbital meningiomas: the rationale behind the decision-making process of treatment strategy. Cancers (Basel). 2024;16(11):2148."},{"issue":"suppl 1","key":"b9","series-title":"Clin Neurosurg","first-page":"45","article-title":"Unilateral exophthalmos","volume":"14","author":"Krayenb\u00fchl HA","year":"1967","unstructured":"Krayenb\u00fchl HA. Unilateral exophthalmos. Clin Neurosurg. 1967;14(suppl 1):45\u201371."},{"issue":"3","key":"b10","series-title":"Neurosurg Clin N Am","first-page":"417","article-title":"Spheno-orbital meningiomas","volume":"34","author":"Rawanduzy CA","year":"2023","unstructured":"Rawanduzy CA, Budohoski KP, Rennert RC, Winkler-Schwartz A, Couldwell WT. Spheno-orbital meningiomas. Neurosurg Clin N Am. 2023;34(3):417\u2013423."},{"key":"b11","series-title":"Surg Neurol Int","first-page":"318","article-title":"Spheno-orbital meningiomas: is orbit reconstruction mandatory? Long-term outcomes and exophthalmos improvement","volume":"13","author":"Dos Santos AG","year":"2022","unstructured":"Dos Santos AG, Paiva WS, da Roz LM,  Spheno-orbital meningiomas: is orbit reconstruction mandatory? Long-term outcomes and exophthalmos improvement. Surg Neurol Int. 2022;13:318."},{"issue":"4 Suppl 2","key":"b12","series-title":"Neurosurgery","first-page":"214","article-title":"Microsurgical technique and results of a series of 63 spheno-orbital meningiomas","volume":"60","author":"Ringel F","year":"2007","unstructured":"Ringel F, Cedzich C, Schramm J. Microsurgical technique and results of a series of 63 spheno-orbital meningiomas. Neurosurgery. 2007;60(4 Suppl 2):214\u2013222."},{"issue":"5","key":"b13","series-title":"Clinical article. J Neurosurg","first-page":"1069","article-title":"Long-term results with exophthalmos in a surgical series of 30 sphenoorbital meningiomas","volume":"111","author":"Scarone P","year":"2009","unstructured":"Scarone P, Leclerq D, H\u00e9ran F, Robert G. Long-term results with exophthalmos in a surgical series of 30 sphenoorbital meningiomas. Clinical article. J Neurosurg. 2009;111(5):1069\u20131077."},{"issue":"6 Suppl","key":"b14","series-title":"Neurosurgery","first-page":"100","article-title":"En plaque sphenoid wing meningiomas: recurrence factors and surgical strategy in a series of 71 patients","volume":"65","author":"Mirone G","year":"2009","unstructured":"Mirone G, Chibbaro S, Schiabello L, Tola S, George B. En plaque sphenoid wing meningiomas: recurrence factors and surgical strategy in a series of 71 patients. Neurosurgery. 2009;65(6 Suppl):100\u2013109."},{"issue":"18","key":"b15","series-title":"J Clin Med","first-page":"5840","article-title":"Surgical treatment of spheno-orbital meningiomas: a systematic review and meta-analysis of surgical techniques and outcomes","volume":"12","author":"Agosti E","year":"2023","unstructured":"Agosti E, Zeppieri M, De Maria L,  Surgical treatment of spheno-orbital meningiomas: a systematic review and meta-analysis of surgical techniques and outcomes. 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World Neurosurg.2020;141:252."},{"issue":"7","key":"b18","series-title":"Acta Neurochir (Wien)","first-page":"1539","article-title":"Surgical management of spheno-orbital meningiomas","volume":"153","author":"Nagatani K","year":"2011","unstructured":"Nagatani K, Takeuchi S, Otani N, Nawashiro H. Surgical management of spheno-orbital meningiomas. Acta Neurochir (Wien). 2011;153(7):1539\u20131541."},{"issue":"1","key":"b19","series-title":"Egypt J Neurol Psychiatry Neurosurg","first-page":"18","article-title":"Spheno-orbital meningiomas: surgical techniques and results","volume":"57","author":"Elborady MA","year":"2021","unstructured":"Elborady MA, Nazim WM. Spheno-orbital meningiomas: surgical techniques and results. Egypt J Neurol Psychiatry Neurosurg. 2021;57(1):18."},{"issue":"5","key":"b20","series-title":"J Neurosurg","first-page":"905","article-title":"Management of bone-invasive, hyperostotic sphenoid wing meningiomas","volume":"107","author":"Bikmaz K","year":"2007","unstructured":"Bikmaz K, Mrak R, Al-Mefty O. Management of bone-invasive, hyperostotic sphenoid wing meningiomas. J Neurosurg. 2007;107(5):905\u2013912."},{"issue":"5","key":"b21","series-title":"J Neurosurg","first-page":"1241","article-title":"Sphenoorbital meningioma: surgical technique and outcome","volume":"114","author":"Oya S","year":"2011","unstructured":"Oya S, Sade B, Lee JH. Sphenoorbital meningioma: surgical technique and outcome. J Neurosurg. 2011;114(5):1241\u20131249."},{"issue":"5","key":"b22","series-title":"J Neurosurg","first-page":"1305","article-title":"Orbital reconstruction and volume in the correction of proptosis after resection of spheno-orbital meningiomas","volume":"140","author":"Murayi R","year":"2024","unstructured":"Murayi R, El-Abtah M, Xiao T, Recinos PF, Kshettry VR. Orbital reconstruction and volume in the correction of proptosis after resection of spheno-orbital meningiomas. J Neurosurg. 2024;140(5):1305\u20131311."},{"issue":"1","key":"b23","series-title":"Acta Neurochir (Wien)","first-page":"164","article-title":"Predictive factors of the postoperative proptosis recovery in surgery of spheno-orbital meningiomas","volume":"166","author":"Baucher G","year":"2024","unstructured":"Baucher G, Troude L, Al-Shabibi T, Avinens V, Fernandes S, Roche PH. Predictive factors of the postoperative proptosis recovery in surgery of spheno-orbital meningiomas. 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