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经蝶骨-眶脑膜瘤切除术后使用可变形钛网进行眼眶重建:眼科表现及结果

Orbital Reconstruction via Deformable Titanium Mesh Following Spheno-Orbital Meningioma Resection: Ophthalmic Presentation and Outcomes.

作者信息

Pace S Tyler, Koreen Irina V, Wilson John A, Yeatts R Patrick

机构信息

Department of Ophthalmology.

Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A.

出版信息

Ophthalmic Plast Reconstr Surg. 2020 Jan/Feb;36(1):89-93. doi: 10.1097/IOP.0000000000001444.

Abstract

PURPOSE

To present a surgical approach to reconstruction of the bony orbit following resection of spheno-orbital meningioma utilizing deformable titanium mesh while emphasizing the ophthalmic presentation and outcomes of the repair.

METHODS

A retrospective chart review received International Review Board approval, and 20 patients met the inclusion criteria. All patients underwent resection of spheno-orbital meningioma followed by orbital reconstruction with deformable titanium mesh. Pre- and postoperative ophthalmic exam findings were recorded. Outcome measures include Snellen visual acuity, performance on automated Humphry 30-2 perimetry, extraocular motility, Hertel exophthalmometry, associated complications, and recurrence. A literature review of the use of titanium to reconstruct the orbit following resection of spheno-orbital meningioma was performed.

RESULTS

Visual acuity improved (9/20) or remained the same (8/20) in 85% of patients. Fifteen of the 20 patients had pre- and postoperative visual fields performed, and 93% (14/15) experienced substantial improvement or no change with full fields. Of the 12 patients who had extraocular motility disturbance following surgery, 25% (3/12) had preexisting defects that did not change, 58% (7/12) returned to normal, and 17% (2/12) had new onset dysfunction that did not improve. Proptosis was reduced by a mean of 4.4 mm. Complications were rare and inconsequential, and recurrence was observed in 20% (4/20) at an average of 43 months following surgery.

CONCLUSIONS

Orbital reconstruction using deformable titanium mesh is both safe and effective in the setting of resection of spheno-orbital meningioma. This study is the largest known report of orbits reconstructed with deformable titanium mesh in the available literature.The ophthalmic presentation of spheno-orbital meningioma and postoperative results are presented following description of orbital reconstruction utilizing deformable titanium mesh.

摘要

目的

介绍一种在切除蝶骨嵴脑膜瘤后利用可变形钛网重建眼眶骨的手术方法,同时强调眼部表现及修复效果。

方法

一项回顾性病历审查获得国际审查委员会批准,20例患者符合纳入标准。所有患者均接受了蝶骨嵴脑膜瘤切除术,随后用可变形钛网进行眼眶重建。记录术前和术后的眼科检查结果。结果指标包括斯内伦视力、自动 Humphrey 30-2视野检查结果、眼球运动、Hertel眼球突出计测量值、相关并发症及复发情况。对蝶骨嵴脑膜瘤切除术后使用钛网重建眼眶的文献进行了综述。

结果

85%的患者视力改善(9/20)或保持不变(8/20)。20例患者中有15例进行了术前和术后视野检查,93%(14/15)的患者视野有显著改善或无变化。在术后出现眼球运动障碍的12例患者中,25%(3/12)术前就存在未改变的缺陷,58%(7/12)恢复正常,17%(2/12)出现新的功能障碍且未改善。眼球突出平均减少4.4毫米。并发症罕见且不严重,20%(4/20)的患者在术后平均43个月出现复发。

结论

在蝶骨嵴脑膜瘤切除术中,使用可变形钛网进行眼眶重建既安全又有效。本研究是现有文献中已知的关于使用可变形钛网重建眼眶的最大规模报告。在描述利用可变形钛网进行眼眶重建后,介绍了蝶骨嵴脑膜瘤的眼部表现及术后结果。

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