Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Chin Med J (Engl). 2009 Oct 20;122(20):2423-7.
Sphenoid wing meningioma en plaque is a special morphological subgroup of intracranial meningiomas, defined by a carpet-like, soft tissue component that infiltrates the dura and invades the sphenoid wing and orbit associated with a significant hyperostosis. This report summarized our experiences in 37 patients with sphenoid wing meningioma en plaque who had been treated with transcranio-orbital approach surgery.
A retrospective study was made on clinical manifestations, neuroradiological features, and operative techniques in 37 patients undergoing transcranio-orbital approach from Sep. 1998 to Apr. 2009. Patients ages: 16 years to 67 years, 45.5 years in average; sex: 15 males, 22 females. Chief complaints were progressive proptosis and visual acuity deficits. All patients were operated on using a fronto-temporal approach with orbital decompression. The extent of tumor resection and postoperative complications were investigated.
Simpson grade II resection was achieved in 9 patients, Simpson grade III in 22 patients and Simpson grade IV in 6 patients. Pathological examination showed 27 (73%) patients were meningothelial meningiomas. After surgery, proptosis improved in all patients, visual acuity improved in 18 patients (69%). Temporary ophthalmoplegia was found in 8 patients, cerebrospinal fluid leak was found in 1 patient. Duration of follow up was from 3 months to 9 years, tumor recurred in 7 patients, and 5 patients underwent second surgery, including two trans-nasal endoscopic surgeries to resect sphenoid sinus-involved tumor. There were no operation-related deaths or other significant complications.
Sphenoid wing meningioma en plaque, mainly meningothelial meningiomas, are more likely to produce adjacent hyperostosis and have characteristic radiological appearances. All the hyperostosis bone of the great wing of sphenoid bone should be removed to prevent recurrence. Extensive tumor removal with bony decompression at the orbital apex can produce satisfactory cosmetic and functional outcome. Close co-operation between the neurosurgeons and the ophthalmologists is important.
蝶骨翼板脑膜瘤斑块是颅内脑膜瘤的一种特殊形态亚组，其特征为软组织结构呈地毯状，侵犯硬膜并累及蝶骨翼和眼眶，同时伴有明显的骨过度生长。本报告总结了我们采用颅眶入路手术治疗 37 例蝶骨翼板脑膜瘤斑块患者的经验。
对 1998 年 9 月至 2009 年 4 月期间采用颅眶入路治疗的 37 例患者的临床表现、神经影像学特征和手术技术进行回顾性研究。患者年龄 16-67 岁，平均年龄 45.5 岁；性别：男 15 例，女 22 例。主要症状为进行性眼球突出和视力下降。所有患者均采用额颞部入路联合眶减压术进行手术。研究肿瘤切除程度和术后并发症。
9 例患者达到 Simpson 分级Ⅱ级切除，22 例患者达到 Simpson 分级Ⅲ级切除，6 例患者达到 Simpson 分级Ⅳ级切除。病理检查显示 27 例（73%）为脑膜上皮型脑膜瘤。术后所有患者的眼球突出均得到改善，18 例（69%）患者的视力得到改善。8 例患者出现暂时性动眼神经麻痹，1 例患者出现脑脊液漏。随访时间 3 个月至 9 年，7 例患者肿瘤复发，5 例患者接受了第二次手术，其中 2 例经鼻内镜切除累及蝶窦的肿瘤。无手术相关死亡或其他严重并发症。
蝶骨翼板脑膜瘤斑块主要为脑膜上皮型脑膜瘤，更易引起邻近骨过度生长，具有特征性的影像学表现。所有蝶骨翼板的骨过度生长均应切除，以防止复发。广泛切除肿瘤并进行眶尖骨减压可获得满意的美容和功能效果。神经外科医生与眼科医生的密切合作非常重要。
