Transorbital management of selected spheno-orbital meningiomas: Insights from a multicentric retrospective Italian study of 52 cases.

Spheno-orbital meningiomas (SOMs) are a rare type of intracranial tumor. Their location and behavior often make radical resection unfeasible. Recently, less invasive techniques have gained traction. The endoscopic transorbital approach (TOA), sometimes combined with lateral orbital rim removal or additional routes, offers a flexible surgical corridor for selected SOMs. This study evaluates the outcomes of TOA in SOM patients across five Italian tertiary centers, focusing on feasibility, safety, symptom relief, and tumor control. A retrospective multicenter study was conducted from January 2012 to December 2022, involving 52 patients treated with TOA. Data on symptoms, functional outcomes, and complications were analyzed. Proptosis was the most common symptom (94.2%), followed by diplopia (36.5%), visual impairment (34.6%), and blindness (3.8%). Orbital extension occurred in 28.8% of cases, cavernous sinus invasion in 21.2%, and infratemporal/pterygopalatine fossa involvement in 21.2%. Thirty-six patients underwent standard TOA, while 16 required multiportal or staged approaches. Gross total resection (GTR) was achieved in 28.8%, subtotal in 23.1%, and partial in 48.1%. Trigeminal hypoesthesia (9.6%) was the most common complication. Proptosis resolved in 50 patients; however, two developed contralateral proptosis. Visual improvement occurred in 31% of cases. TOA appears feasible and safe for selected SOMs, especially for addressing proptosis. However, extensive tumor spread, large size, or vascular invasion are linked to lower GTR rates. Ideal candidates and formal guidelines are yet to be defined, but TOA represents a promising minimally invasive strategy in appropriate cases.