Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Neurosurgery. 2010 Dec;67(2 Suppl Operative):377-84. doi: 10.1227/NEU.0b013e3181f8d3ad.
Sphenoid wing meningiomas are slow-growing, well-circumscribed, and histologically benign lesions. The recurrence rate is low if removed completely at the time of surgery. Adequate surgical exposure with minimal morbidity is a challenge for those treating these lateral skull base lesions.
To describe our experience with the lateral tranzygomatic approach for resection of sphenoid wing meningioms in which the entire zygoma is mobilized and remains vascularized by masseter muscle attachments.
A retrospective review of the records of 19 patients who underwent sphenoid wing meningioma resection via a lateral transzygomatic approach between 1997 and 2007 was performed. A confirmatory cadaver dissection was performed to illustrate the anatomic nature of the technique. To achieve maximal exposure and minimal brain retraction, a lateral transzygomatic approach with osteotomies of the entire zygoma, which remains pedicled on the masseter muscle, was used.
Nineteen patients with sphenoid wing meningioma underwent resection via a lateral transzygomatic approach. Complete resection of the meningioma was achieved in 17 cases. Morbidity consisted of temporary frontal nerve weakness (57.9%), mild to moderate temporalis atrophy (36.8%), and diplopia (15.8%). There were no cases of wound infection, bone malunion, or resorption. A mean follow-up period of 33.1 months (range, 2-71 months) revealed no recurrences after surgery as demonstrated by computed tomography or magnetic resonance imaging.
The lateral transzygomatic approach to the sphenoid wing can be performed safely with minimal morbidity and facilitates complete resection of the tumor. Complete removal at an early stage is the best prognostic factor in treating sphenoid wing meningioma. This approach belongs in the armamentarium of surgeons who are involved in the resection of skull base neoplasms.
蝶骨翼脑膜瘤生长缓慢，边界清楚，组织学上为良性病变。如果在手术时完全切除，复发率很低。对于治疗这些颅底外侧病变的医生来说，充分暴露并尽量减少发病率是一个挑战。
描述我们采用外侧经颧骨入路切除蝶骨翼脑膜瘤的经验，在该入路中，整个颧骨被移动，并通过咬肌附着保持血供。
对 1997 年至 2007 年间采用外侧经颧骨入路切除蝶骨翼脑膜瘤的 19 例患者的病历进行回顾性分析。进行了尸体解剖以验证该技术的解剖学特性。为了达到最大的暴露和最小的脑牵拉，我们采用了外侧经颧骨入路，整块颧骨截骨，颧骨通过咬肌保持蒂状。
19 例蝶骨翼脑膜瘤患者采用外侧经颧骨入路切除。17 例患者脑膜瘤完全切除。并发症包括暂时性额神经无力（57.9%）、轻度至中度颞肌萎缩（36.8%）和复视（15.8%）。无伤口感染、骨愈合不良或吸收。平均随访 33.1 个月（范围 2-71 个月），术后无复发，通过 CT 或 MRI 证实。
采用外侧经颧骨入路治疗蝶骨翼是安全的，发病率低，有利于肿瘤的完全切除。早期完全切除是治疗蝶骨翼脑膜瘤的最佳预后因素。这种方法属于参与颅底肿瘤切除的外科医生的武器库。
