Departments of1Neurological Surgery.
2Otolaryngology, and.
J Neurosurg. 2018 Jun;128(6):1885-1895. doi: 10.3171/2017.3.JNS163110. Epub 2017 Sep 1.
Sphenoorbital meningiomas (SOMs) are slow-growing tumors that originate from the sphenoidal wing and are associated with visual deterioration, extrinsic ocular movement disorders, and proptosis caused by hyperostosis of the lateral wall of the orbit. In some cases, the intracranial component is quite small or "en plaque," and the majority of the symptoms arise from adjacent hyperostosis. Craniotomy has traditionally been the standard of care, but new minimally invasive multiportal endoscopic approaches offer an alternative. In the current study, the authors to present their experience with the transorbital endoscopic eyelid approach for the treatment of 2 patients with SOMs and sphenoid wing hyperostosis. Clinical and radiological data for patients with SOMs who underwent a transorbital endoscopic eyelid approach were retrospectively reviewed. Surgical technique and clinical and radiographic outcomes were analyzed. The authors report the cases of 2 patients with SOMs and proptosis due to sphenoid wing hyperostosis. One patient underwent prior craniotomy to debulk the intracranial portion of the tumor, and the other had a minimal intracranial component. Both patients were discharged 2 days after surgery. MR images and CT scans demonstrated a large debulking of the hyperostotic bone. Postoperative measurement of the proptosis with the aid of an exophthalmometer demonstrated significant reduction of the proptosis in one of the cases. Persistence of intraconal tumor in the orbital apex limited the efficacy of the procedure in the other case. A review of the literature revealed 1 publication with 3 reports of the transorbital eyelid approach for SOMs. No measure of relief of proptosis after this surgery had been previously reported. The transorbital endoscopic approach, combined with endonasal decompression of the medial orbit, may be a useful minimally invasive alternative to craniotomy in a subset of SOMs with a predominantly hyperostotic orbital wall and minimal intracranial bulky or merely en plaque disease. In these cases, relief of proptosis and optic nerve compression are the primary goals of surgery, rather than gross-total resection, which may have high morbidity or be unachievable. In cases with significant residual intraconal tumor, orbital bone removal alone may not be sufficient to reduce proptosis.
蝶眶脑膜瘤（SOMs）是一种生长缓慢的肿瘤，起源于蝶骨翼，与视力恶化、眼外肌运动障碍和眼眶外侧壁骨质增生引起的眼球突出有关。在某些情况下，颅内部分非常小或呈“贴壁型”，大多数症状是由相邻骨质增生引起的。开颅手术一直是标准的治疗方法，但新的微创多通道内镜方法提供了一种替代方法。在目前的研究中，作者介绍了他们使用经眶内镜眼睑入路治疗 2 例 SOM 和蝶骨翼骨质增生的经验。回顾性分析了经眶内镜眼睑入路治疗 SOM 患者的临床和影像学资料。分析了手术技术和临床及影像学结果。作者报告了 2 例 SOM 患者的病例，这些患者由于蝶骨翼骨质增生而出现眼球突出。1 例患者曾行开颅手术以缩小肿瘤的颅内部分，另 1 例患者颅内部分很小。术后 2 天，2 例患者均出院。MR 图像和 CT 扫描显示骨质增生有很大程度的缩小。在外眼突出计的帮助下，术后对眼球突出进行了测量，1 例患者的眼球突出明显减少。另 1 例病例由于眶尖内肿瘤的存在，限制了手术的疗效。对文献的回顾发现，有 1 篇文献报道了 3 例 SOM 经眶内镜眼睑入路。此前，没有关于这种手术治疗后眼球突出缓解的报道。经眶内镜入路联合经鼻内眶内侧减压术，可能是一种有用的微创替代开颅手术的方法，适用于主要表现为眶壁骨质增生和颅内肿块较小或仅呈“贴壁型”的 SOM 患者。在这些病例中，缓解眼球突出和视神经压迫是手术的主要目标，而不是全切除肿瘤，因为全切除肿瘤可能会带来较高的发病率或无法实现。对于有明显残留眶内肿瘤的病例，单纯去除眶骨可能不足以减轻眼球突出。
