Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
World Neurosurg. 2019 Jun;126:e679-e687. doi: 10.1016/j.wneu.2019.02.123. Epub 2019 Mar 4.
Spheno-orbital meningioma (SOM) is a rare intracranial tumor that arises at the sphenoid wing, extends into the orbit, and is associated with hyperostosis of the sphenoid bone. These tumors often invade important neurovascular structures around the orbital apex, superior orbital fissure, and cavernous sinus. Aggressive tumor removal could achieve acceptable control; however, residual tumor can regrow. In this article, our surgical management and long-term outcomes are described.
Retrospectively, 12 patients with SOM who were treated surgically over a 21-year period were included. The clinical features and long-term tumor control were evaluated.
Participants comprised 12 patients (5 men and 7 women). Mean follow-up was 74.4 months (range, 10-262 months). Ten patients (83%) were identified as World Health Organization grade 1 (WHO-I), and 2 patients (17%) were identified as WHO grade 2 (WHO-II). We encountered 4 recurrences, 2 of which needed additional surgeries. One patient with WHO-I (10%) experienced recurrence 10 years after the initial surgery and required a second surgery. Two patients with WHO-I (20%) showed slight regrowth of residual tumor around the superior orbital fissure; nevertheless, additive therapy was not recommended. Despite radical tumor resection, including eyeball and adjunctive radiotherapy for 1 patient with WHO-II, tumor recurrence in the posterior fossa was documented 19 years after the initial aggressive surgery.
SOM follows a relatively benign clinical course given the invasive radiologic findings. Abnormal bone resection is paramount to prevent early-stage recurrence. Although intradural residual tumor might regrow, additional surgery could achieve reasonable long-term tumor control with better outcome.
蝶眶脑膜瘤（SOM）是一种罕见的颅内肿瘤，起源于蝶骨翼，延伸至眼眶，并伴有蝶骨骨质增生。这些肿瘤常侵犯眶尖、眶上裂和海绵窦周围的重要神经血管结构。积极的肿瘤切除可以获得可接受的控制效果；然而，残留的肿瘤可能会复发。本文描述了我们的手术治疗和长期结果。
回顾性分析了 21 年间接受手术治疗的 12 例 SOM 患者。评估了患者的临床特征和长期肿瘤控制情况。
共纳入 12 例患者（5 例男性，7 例女性）。平均随访时间为 74.4 个月（范围为 10-262 个月）。10 例（83%）患者被诊断为世界卫生组织分级 1（WHO-I），2 例（17%）患者被诊断为 WHO 分级 2（WHO-II）。我们共发现 4 例复发，其中 2 例需要再次手术。1 例 WHO-I 患者（10%）在初次手术后 10 年复发，需要再次手术。2 例 WHO-I 患者（20%）在眶上裂处残留肿瘤有轻微增长，但不建议进行附加治疗。尽管对 1 例 WHO-II 患者进行了包括眼球切除和辅助放疗的激进肿瘤切除术，但在初次积极手术后 19 年，仍记录到了后颅窝肿瘤复发。
鉴于侵袭性的影像学发现，SOM 的临床病程相对良性。异常骨切除对于预防早期复发至关重要。尽管硬脑膜内残留肿瘤可能会再次生长，但额外的手术可以实现合理的长期肿瘤控制，并获得更好的结果。
