Department of Neurosurgery, Hôpital Lariboisière, Paris, France.
Neurosurgery. 2009 Dec;65(6 Suppl):100-8; discussion 108-9. doi: 10.1227/01.NEU.0000345652.19200.D5.
En plaque sphenoid wing meningiomas are complex tumors involving the sphenoid wing, the orbit, and sometimes the cavernous sinus. Complete removal is difficult, so these tumors have high rates of recurrence and postoperative morbidity. The authors report a series of 71 patients with sphenoid wing meningiomas that were managed surgically.
The clinical records of 71 consecutive patients undergoing surgery for sphenoid wing meningiomas at Lariboisière Hospital, Paris, were prospectively collected in a database during a 20-year period and analyzed for presenting symptoms, surgical technique, clinical outcome, and follow-up.
Among the 71 patients (mean age, 52. 7 years; range, 12-79 years), 62 were females and 9 were males. The most typical symptoms recorded were proptosis in 61 patients (85.9%), visual impairment in 41 patients (57.7%), and oculomotor paresis in 9 patients (12.7%). Complete removal was achieved in 59 patients (83%). At 6 months of follow-up, magnetic resonance imaging scans revealed residual tumor in 12 patients (9 in the cavernous sinus and 3 around the superior orbital fissure). Mean follow-up was 76.8 months (range, 12-168 months). Tumor recurrence was recorded in 3 of 59 patients (5%) with total macroscopic removal. Among the patients with subtotal resection, tumor progression was observed in 3 of 12 patients (25%; 2 patients with grade III and 1 patient with grade IV resection). Mean time to recurrence was 43.3 months (range, 32-53 months).
Surgical management of patients with sphenoid wing meningiomas cannot be uniform; it must be tailored on a case-by-case basis. Successful resection requires extensive intra- and extradural surgery. We recommend optic canal decompression in all patients to ameliorate and/or preserve visual function.
板障型蝶骨翼脑膜瘤是一种复杂的肿瘤，涉及蝶骨翼、眼眶，有时还涉及海绵窦。完全切除很困难，因此这些肿瘤的复发率和术后发病率都很高。作者报告了一组 71 例蝶骨翼脑膜瘤患者的手术治疗结果。
在 20 年的时间里，前瞻性地在巴黎 Lariboisière 医院的数据库中收集了 71 例连续接受蝶骨翼脑膜瘤手术的患者的临床记录，并对其临床表现、手术技术、临床结果和随访情况进行了分析。
71 例患者（平均年龄 52.7 岁；年龄范围 12-79 岁）中，女性 62 例，男性 9 例。最常见的症状是 61 例（85.9%）患者出现眼球突出，41 例（57.7%）患者出现视力损害，9 例（12.7%）患者出现动眼神经麻痹。59 例（83%）患者实现了肿瘤全切。术后 6 个月的磁共振成像（MRI）扫描显示 12 例患者（9 例位于海绵窦，3 例位于眶上裂）有肿瘤残留。平均随访时间为 76.8 个月（范围 12-168 个月）。59 例实现全切的患者中有 3 例（5%）复发。在 12 例次全切的患者中，有 3 例（25%）肿瘤进展，其中 2 例为 III 级切除，1 例为 IV 级切除。复发的平均时间为 43.3 个月（范围 32-53 个月）。
对蝶骨翼脑膜瘤患者的手术治疗不能一刀切，必须根据具体情况进行个体化处理。要实现成功切除，需要进行广泛的颅内和颅外手术。我们建议所有患者都进行视神经管减压，以改善和/或保留视力功能。
