Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK.
Acta Neurochir (Wien). 2013 Jun;155(6):981-8. doi: 10.1007/s00701-013-1662-8. Epub 2013 Mar 10.
Although meningiomas of the spheno-orbital region commonly result in hyperostosis, intraosseous meningiomas, which feature extensive full thickness infiltration of the anterolateral skull base, are rare. In this study, we assess the value of image guidance during surgery for intraosseous spheno-orbital skull-base meningiomas in achieving safe and maximal abnormal bone resection.
Only cases with a full thickness and extensive intraosseous component were included. Image guidance was used to guide drilling of hyperostotic bone. Extensive resulting defects of the orbital wall were reconstructed with titanium mesh. Post-operative CT scans were used to assess completeness of abnormal bone resection in the skull base, and MRI scans used to evaluate residual intradural disease. Operative complications to neurovascular structures in adjacent foramina were recorded.
Nineteen patients with full-thickness intraosseous spheno-orbital meningiomas underwent image-guided resection. Anterior clinoidectomy to variable extent was necessary in 11 cases with decompression of the optic canal in five. In ten cases, hyperostotic bone was drilled from the middle fossa around the exit foramina of the trigeminal nerve and base of the pterygoid plates. Proptosis was corrected in all cases, and of 11 patients presenting with reduced visual acuity, symptoms improved or stabilized in ten cases. Post-operative CT scans confirmed gross resection of abnormal bone in all cases, but limited residual tumor was present around the cavernous sinus or orbital apex in eight patients. One patient died from a pulmonary embolism, the only mortality of the series. One patient had worsening of pre-existing poor visual acuity, and three patients had worsening of pre-existing ophthalmoplegia. Five patients developed new facial numbness post-operatively, which persisted in three cases.
Intra-operative image guidance allowed total or near-total resection of the hyperostotic skull base around the cranial nerve foramina with minimal morbidity in a group of patients with extensive spheno-orbital meningiomas.
尽管蝶眶区脑膜瘤常导致骨质增生，但广泛累及颅前窝外侧壁的骨内脑膜瘤则较为罕见。本研究旨在评估术中影像学引导在实现安全、最大程度异常骨切除方面对骨内蝶眶颅底脑膜瘤的价值。
仅纳入全层、广泛骨内成分的病例。影像学引导用于指导骨质增生的钻孔。眶壁广泛缺损采用钛网重建。术后 CT 扫描评估颅底异常骨切除的完整性，MRI 扫描评估颅内残留病变。记录毗邻孔内神经血管结构的手术并发症。
19 例全层骨内蝶眶脑膜瘤患者行影像学引导下切除术。11 例患者行前床突切除术，5 例视神经减压。10 例患者从中颅窝围绕三叉神经出口孔和翼突基底部钻除骨质增生。所有患者眼球突出均得到矫正，11 例视力下降患者中，10 例症状改善或稳定。术后 CT 扫描证实所有患者均实现异常骨的大体全切除，但 8 例患者仍有海绵窦或眶尖残留肿瘤。1 例患者死于肺栓塞，为本系列唯一死亡病例。1 例患者原有视力差加重，3 例原有眼肌麻痹加重。术后 5 例患者出现新的面部麻木，其中 3 例持续存在。
术中影像学引导使我们能够在一组广泛蝶眶脑膜瘤患者中，在最小的并发症风险下，切除颅神经孔周围的骨质增生，实现大体全切除或近全切除。
