DOTATATE-PET in custom spheno-orbital implant design for meningiomas with orbital involvement: a case series.
Integrating DOTATATE-PET imaging with custom implants may improve surgical outcomes for patients with hyperostosing spheno-orbital meningiomas, but further studies are needed to confirm these findings.
Where it sits
this study against the rest of the octreotide corpusSummary and findings
This study evaluated the use of DOTATATE-PET imaging in the surgical management of hyperostosing spheno-orbital meningiomas (SOMs) in four patients. All patients underwent cranio-orbital resection and rigid orbital reconstruction with custom implants. The exophthalmos index improved in all patients, with varying degrees of visual outcome stabilization.
Abstract
<h4>Objective</h4>Hyperostosing spheno-orbital meningiomas (SOMs) infiltrate bone and cause bone overgrowth leading to progressive visual and cosmetic deformities. DOTA0-Tyr3-octreotate (DOTATATE) is a somatostatin receptor-targeted PET ligand that enables highly sensitive identification of meningiomas. This ligand is useful in defining the extent of bone infiltration by the meningioma, which can be difficult to detect on standard CT and MRI. In this study, the authors aimed to provide a pragmatic technical framework for integrating molecular imaging, navigation, and patient-specific reconstruction in the management of complex SOMs by reporting their experience designing custom spheno-orbital implants based on DOTATATE-PET for skull and orbital reconstruction, as well as to report patient outcomes.<h4>Methods</h4>Four patients with SOMs who underwent cranio-orbital resection and rigid orbital reconstruction with custom polyetheretherketone patient-specific implants (PSIs) at a single center between 2023 and 2025 were retrospectively reviewed. Three patients had DOTATATE-PET/CT data available, and all had undergone CT and MRI to delineate tumor extent and guide implant design. All surgical procedures involved a multidisciplinary neurosurgery-oculoplastics team. The exophthalmos index was measured pre- and postoperatively.<h4>Results</h4>All patients underwent tumor resection with a single PSI for skull and orbital reconstruction. Gross-total resection was achieved in 1 patient. Radiotracer-defined transosseous tumor involvement extended beyond the structural hyperostosis seen on CT and MRI and directly informed both the planned bony resection and PSI design. Visual outcomes stabilized or improved in all patients; 1 pediatric patient with neurofibromatosis type 2 (NF2) had persistent poor vision despite decompression due to significant tumor involvement at the orbital apex. The exophthalmos index improved in all patients, with a return to normal globe position in 3 patients and persistent proptosis due to intraorbital residual tumor in 1 patient. One patient developed transient diplopia and a pseudomeningocele, which resolved with conservative management. There were no enophthalmos or implant-related complications.<h4>Conclusions</h4>Integrating DOTATATE-PET with custom cranio-orbital PSIs allows single implant reconstruction of combined skull and orbital defects after resection of hyperostosing SOMs. DOTATATE-PET is useful for defining transosseous tumor extent and informing implant design. By enlarging the orbital volume with the implant compared with the contralateral normal side, excellent correction of proptosis can be achieved.
Background
This paper addresses the clinical challenge of managing hyperostosing spheno-orbital meningiomas (SOMs), which can cause significant visual and cosmetic deformities due to bone overgrowth. Prior knowledge indicates that traditional imaging modalities may struggle to accurately delineate the extent of tumor infiltration. The integration of DOTATATE-PET imaging aims to enhance surgical planning and outcomes by providing detailed information about tumor extent.
Methods
This is a retrospective case series involving four patients with SOMs who underwent cranio-orbital resection and rigid orbital reconstruction using custom polyetheretherketone patient-specific implants (PSIs) at a single center from 2023 to 2025. Three patients had DOTATATE-PET/CT data available, and all had undergone CT and MRI for tumor delineation. The primary outcome measure was the exophthalmos index, assessed pre- and postoperatively.
Results
All patients underwent tumor resection with a single PSI for skull and orbital reconstruction. The exophthalmos index improved in all patients, with a return to normal globe position in 3 patients. Visual outcomes stabilized or improved in all patients, although one pediatric patient experienced persistent poor vision due to significant tumor involvement.
Interpretation
The study suggests that integrating DOTATATE-PET with custom PSIs may enhance surgical outcomes for patients with SOMs. While the findings indicate improvements in the exophthalmos index and stabilization of visual outcomes, the clinical significance of these results is uncertain given the small sample size and lack of control group. The study's limitations, including its retrospective nature and single-center design, may confound the conclusions drawn.
Key findings
- Gross-total resection achieved in 1 patient.
- Exophthalmos index improved in all patients.
- Normal globe position returned in 3 patients.
- Persistent proptosis due to intraorbital residual tumor in 1 patient.
- One patient developed transient diplopia and a pseudomeningocele.
Limitations
- small sample size of n=4
- retrospective design limits causal inference
- single-center study may affect generalizability
- no control group for comparison