Shin Masahiro, Shojima Masaaki, Kondo Kenji, Hasegawa Hirotaka, Hanakita Shunya, Ito Akihiro, Kin Taichi, Saito Nobuhito
Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan.
Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan.
World Neurosurg. 2018 Apr;112:e302-e312. doi: 10.1016/j.wneu.2018.01.041. Epub 2018 Jan 12.
Skull base meningiomas carry a nonnegligible risk of recurrence. In particular, those arising from the sphenoid wings or middle cranial fossa penetrate into extracranial regions, uncommonly showing massive expansion into the craniofacial regions on recurrence. The role of endoscopic endonasal surgery for those intractable lesions remains unclear.
We performed endoscopic endonasal craniofacial surgery for 8 recurrent meningiomas invading into the pterygopalatine fossa, infratemporal fossa, nasopharynx, paranasal sinus, or orbit, comprising 2 meningothelial and 1 fibrous meningiomas (World Health Organization [WHO] grade I), 3 atypical and 1 clear cell meningiomas (grade II), and 1 anaplastic meningioma (grade III). All were large (15-80 cm; median, 45 cm) and highly vascularized.
All 8 tumors were sufficiently resected. Gross total resection of the craniofacial part of the lesions was achieved in 5 patients (62.5%). In 3 patients with WHO grade I meningiomas and 1 with grade II, tumors were successfully controlled as of the last follow-up. In 4 patients with WHO grade II or III meningiomas, craniofacial lesions were controlled, whereas original intracranial lesions were poorly controlled and became critical.
We consider the endoscopic endonasal approach as an acceptable, less-invasive alternative for recurrent craniofacial meningioma. Although all these cases were relatively large and highly vascularized, preoperative endovascular embolization of the feeding arteries contributes to significantly reducing vascularity of the tumors, and local control of the craniofacial lesions was successfully achieved in all cases. Endoscopic endonasal craniofacial surgery enabled sufficient mass reduction without disfiguring facial incisions.
颅底脑膜瘤具有不可忽视的复发风险。特别是那些起源于蝶骨翼或中颅窝的脑膜瘤会侵入颅外区域，复发时罕见地出现向颅面部区域的大量扩展。内镜鼻内手术对这些难治性病变的作用仍不明确。
我们对8例复发性脑膜瘤进行了内镜鼻内颅面手术，这些脑膜瘤侵犯翼腭窝、颞下窝、鼻咽、鼻窦或眼眶，包括2例脑膜内皮型和1例纤维型脑膜瘤（世界卫生组织[WHO]I级）、3例非典型和1例透明细胞脑膜瘤（II级）以及1例间变性脑膜瘤（III级）。所有肿瘤均体积较大（15 - 80 cm；中位数为45 cm）且血运丰富。
8例肿瘤均获充分切除。5例患者（62.5%）实现了病变颅面部部分的全切除。在3例WHO I级脑膜瘤患者和1例II级患者中，截至末次随访肿瘤得到成功控制。在4例WHO II级或III级脑膜瘤患者中，颅面部病变得到控制，而原颅内病变控制不佳并变得严重。
我们认为内镜鼻内入路是复发性颅面部脑膜瘤一种可接受的、侵入性较小的替代方法。尽管所有这些病例肿瘤相对较大且血运丰富，但术前对供血动脉进行血管内栓塞有助于显著减少肿瘤血运，并且所有病例均成功实现了颅面部病变的局部控制。内镜鼻内颅面手术能够充分减轻肿瘤体积，同时避免面部切口造成毁容。
