**5. Therapeutic strategy and decision-making algorithm**

As with all other meningiomas, the decision-making process for SOM must be tailored to each patient. Mass effect of the tumor, age, general condition, comorbidities, symptomatology, its impact on daily life, and the patient's wishes must be taken into account. In cases with absent or mild symptoms without mass effect on imaging, simple clinical and radiological monitoring can be chosen initially, with patient follow-up on a regular basis (every 3–6 months). In contrast, the presence of optic neuropathy, severe neurological symptoms, significant proptosis, or serious mass effect warrants surgical operation. Although a subject of debate, optimal

#### **Figure 3.**

*Decision-making algorithm of first-line treatment for spheno-orbitary meningiomas, in accordance with the 2016 EANO guidelines [16]. The choice of radiation treatment is mainly based on the tumor volume, stereotactic radiosurgery being preferred for smaller tumors and radiotherapy being preferred for larger tumors.*

#### *Spheno-Orbital Meningiomas DOI: http://dx.doi.org/10.5772/intechopen.101983*

surgical resection remains the current reference treatment for SOM, in accordance with the general EANO (European Association of Neuro-Oncology) guidelines for the management of meningiomas published in 2016 [16]. If the patient is in a fragile state of health or categorically refuses the operation, radiation treatment may be offered as an alternative. The choice of technique is then mainly based on the tumor volume, stereotactic radiosurgery being preferred for smaller tumors and radiotherapy being preferred for larger tumors. To summarize this reasoning, we propose a simple algorithm highlighting the main points to be taken into account during decision-making in cases of SOM (**Figure 3**).
