Essa Abdelhakeem A, Hamdan Ali R
Department of Neurosurgery, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt.
Department of Neurosurgery, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
Clin Neurol Neurosurg. 2018 Apr;167:147-156. doi: 10.1016/j.clineuro.2018.02.028. Epub 2018 Feb 21.
To evaluate surgical outcome and reconstruction of bone defects after excision of sphenoid meningioma enplaque.
Between June 2012 and May 2016, a series of 15 patients presented by proptosis attended to neurosurgery departments, Assiut university hospital, Qena university hospital, South Valley University and, These patients were diagnosed with sphenoid meningioma enplaque by fulfilling its criteria by neuroimaging (sheet-like meningioma and hyperostosis). All patients received preoperative imaging investigations including Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) to evaluate the extension of both tumor components - soft tissue and bone involvement. Fifteen patients were operated by pterional approach under general anesthesia.
Fifteen patients with meningioma enplaque were treated surgically. The mean age of patients at the time of admission was 46.5 years, age ranged between 35-56 years. 80% of patients were females (female to male ratio was 4:1). Ten (66.7%) patients have left sided lesion representing. Proptosis was the main presented manifestation in all patients. Complete tumor excision was done in 10 patients while incomplete excision was done in the rest of patients. Proptosis was improved post-operatively in patients presented by it: Ten (66.7%) patients had complete improvement while the other five (33.3%) patients improved significantly. No mortality occurred in our study. A mean follow-up period of 2.1 years (range: 4 months to 4 years), three (20%) patients have tumor recurrence.
Total excision of Sphenoid meningioma enplaque carries difficulties and high rate of post-operative morbidity. Early detection with experienced neurosurgeons, microsurgical techniques and availability of high speed drill decrease the risk of post-operative morbidity. Reconstruction of dural and bone defect is very important regarding functional and cosmetic aspects.
评估蝶骨平板状脑膜瘤切除术后的手术效果及骨缺损重建情况。
2012年6月至2016年5月期间，一系列15例因眼球突出就诊于阿斯尤特大学医院、基纳大学医院、南谷大学神经外科的患者，通过神经影像学检查（片状脑膜瘤及骨质增生）符合蝶骨平板状脑膜瘤诊断标准。所有患者均接受了包括计算机断层扫描（CT）和磁共振成像（MRI）在内的术前影像学检查，以评估肿瘤的两个组成部分——软组织和骨质受累情况。15例患者在全身麻醉下采用翼点入路进行手术。
15例平板状脑膜瘤患者接受了手术治疗。患者入院时的平均年龄为46.5岁，年龄范围在35 - 56岁之间。80%的患者为女性（男女比例为4:1）。10例（66.7%）患者病变位于左侧。眼球突出是所有患者的主要表现。10例患者实现了肿瘤全切，其余患者为次全切除。以眼球突出为表现的患者术后眼球突出情况得到改善：10例（66.7%）患者完全改善，另外5例（33.3%）患者明显改善。本研究中无死亡病例。平均随访期为2.1年（范围：4个月至4年），3例（20%）患者出现肿瘤复发。
蝶骨平板状脑膜瘤全切存在困难且术后并发症发生率高。经验丰富的神经外科医生早期诊断、显微外科技术以及高速磨钻的应用可降低术后并发症风险。硬膜和骨缺损的重建在功能和美观方面非常重要。
