Solmaz Ilker, Tehli Ozkan, Temiz Caglar, Kural Cahit, Hodaj Irgen, Kutlay Murat, Gonul Engin, Daneyemez Mehmet K
Gulhane Military Medical Academy, Department of Neurosurgery, Ankara, Turkey.
Turk Neurosurg. 2014;24(6):859-66. doi: 10.5137/1019-5149.JTN.10336-14.3.
Surgical removal of sphenoorbital meningiomas is challenging for neurosurgeons. The aim of study is to share our experience on sphenoorbital meningiomas and to provide a picture of the current state of the art in surgical treatment of these tumors.
The data of 13 cases of sphenoorbital meningioma who were operated between 2006 and 2013 was reviewed retrospectively. Intraorbital extension was present in 10 cases while sphenoid bone invasion was detected in 9 cases. All patients underwent surgical treatment after the radiological evaluation with magnetic resonance imaging and computed tomography. The degree of resection and the clinical outcome of all patients were analyzed.
Extended pterional approach with a large frontotemporal craniotomy was performed in all cases. Simpson's grade I and II excision was achieved in 4 (31%) cases while subtotal excision (Simpson's grade III or higher) was performed in 9 cases. The main reason for subtotal excision was the cavernous sinus invasion. Optic canal decompression was performed in patients with intraorbital invasion.
Although total removal is the main objective of surgery, the sphenoorbital meningiomas are difficult to resect especially with cavernous sinus invasion. But in the meantime, it is not recommended to take any excessive risks to achieve a greater degree of resection for a benign tumor. Endoscopic approach is an option for inferomedial orbital parts of these tumors.
蝶眶脑膜瘤的手术切除对神经外科医生而言具有挑战性。本研究的目的是分享我们在蝶眶脑膜瘤方面的经验，并呈现这些肿瘤外科治疗的当前技术水平。
回顾性分析2006年至2013年间接受手术的13例蝶眶脑膜瘤患者的数据。10例存在眶内扩展，9例检测到蝶骨侵犯。所有患者在经磁共振成像和计算机断层扫描进行放射学评估后均接受了手术治疗。分析了所有患者的切除程度和临床结果。
所有病例均采用扩大翼点入路并进行大型额颞开颅手术。4例（31%）实现了辛普森一级和二级切除，9例进行了次全切除（辛普森三级或更高等级）。次全切除的主要原因是海绵窦侵犯。对存在眶内侵犯的患者进行了视神经管减压。
尽管手术的主要目标是全切，但蝶眶脑膜瘤尤其是伴有海绵窦侵犯时难以切除。但与此同时，对于良性肿瘤，不建议为实现更大程度的切除而冒任何过度风险。内镜入路是这些肿瘤眶内下部分的一种选择。
