Forster Marie-Thérèse, Daneshvar Keivan, Senft Christian, Seifert Volker, Marquardt Gerhard
Neurol Res. 2014 Aug;36(8):695-700. doi: 10.1179/1743132814Y.0000000329. Epub 2014 Feb 11.
Surgical management of sphenoorbital meningiomas ranges among the most complex of intracranial tumors. We report on our experience of surgical technique, outcome, and tumor recurrence in sphenoorbital meningiomas.
Between 2003 and 2013, surgical resections for sphenoorbital meningioma were performed in 18 patients (aged 49·6±9·8 years, only women), with two patients operated anew due to tumor recurrence.
Main symptom was proptosis (83·3%), followed by diminished visual acuity (38·9%), and dizziness (11·1%). In all patients the lateral orbital wall was resected, whereas the orbital roof and the zygoma were removed according to the extent of their tumorous infiltration. Unroofing of the optic canal was performed in 10 cases (55·6%) and unroofing of the optic foramen in two (11·1%). For reconstruction split calvarian bone and titanium mesh were used in six (33·3%) and seven patients (38·9%), respectively; in one patient both techniques were applied. In five patients (27·8%), no reconstruction was necessary. Complete tumor resection (Simpson grade 1 and 2) was achieved in 14 cases (77·7%). Postoperatively, proptosis improved in all patients. Median follow-up was 39·5±33·3 months (range 1-105) in 16 patients; 2 patients were lost to follow-up. No tumor recurrence was noted in five (27·8%) patients, whereas in nine (50%) patients tumor remnants proved stable over time. Two (11·1%) patients experienced progression of residual tumor, resulting in reoperation after 27 and 109 months, respectively.
Despite their delicate anatomical relations, surgery of sphenoorbital meningiomas is safe when combining modern techniques.
蝶眶脑膜瘤的手术治疗是颅内肿瘤中最为复杂的手术之一。我们报告蝶眶脑膜瘤的手术技术、治疗结果及肿瘤复发情况。
2003年至2013年期间，对18例蝶眶脑膜瘤患者（年龄49.6±9.8岁，均为女性）进行了手术切除，其中2例因肿瘤复发再次手术。
主要症状为眼球突出（83.3%），其次为视力下降（38.9%）和头晕（11.1%）。所有患者均切除了眶外侧壁，眶顶和颧骨根据肿瘤浸润范围进行切除。10例（55.6%）患者进行了视神经管减压，2例（11.1%）患者进行了视神经孔减压。分别有6例（33.3%）和7例（38.9%）患者使用劈开颅骨骨瓣和钛网进行重建；1例患者同时应用了这两种技术。5例（27.8%）患者无需重建。14例（77.7%）患者实现了肿瘤全切（辛普森1级和2级）。术后，所有患者的眼球突出均有所改善。16例患者的中位随访时间为39.5±33.3个月（范围1 - 105个月）；2例患者失访。5例（27.8%）患者未出现肿瘤复发，而9例（50%）患者的肿瘤残余随时间推移保持稳定。2例（11.1%）患者的残余肿瘤进展，分别在27个月和109个月后再次手术。
尽管蝶眶脑膜瘤的解剖关系复杂，但结合现代技术进行手术是安全的。
