Departments of1Neurological Surgery.
2Radiology, and.
J Neurosurg. 2020 Mar 6;134(3):711-720. doi: 10.3171/2019.12.JNS192543. Print 2021 Mar 1.
Hyperostosing sphenoid wing meningiomas cause bony hyperostosis that may extend into the orbit, resulting in proptosis, restriction of extraocular movements, and/or compressive optic neuropathy. The extent of bony removal necessary and the optimal reconstruction strategy to prevent enophthalmos is debated. Herein, the authors present their surgical outcomes and reconstruction results.
This is a retrospective review of 54 consecutive patients undergoing resection of sphenoid wing meningiomas associated with bony hyperostosis. The majority of cases were operated on by the senior author. Extent of tumor resection, volumetric bone resection, radiographic exophthalmos index, complications, and recurrence were analyzed.
The median age of the cohort was 52.1 years, with women comprising 83% of patients. Proptosis was a presenting symptom in 74%, and 52% had decreased visual acuity. The WHO grade was I (85%) or II (15%). The median follow-up was 2.6 years. On volumetric analysis, a median 86% of hyperostotic bone was resected. Gross-total resection of the intracranial tumor was achieved in 43% and the orbital tumor in 27%, and of all intracranial and orbital components in 20%. Orbital reconstruction was performed in 96% of patients. Postoperative vision was stable or improved in 98% of patients and diplopia improved in 89%. Postoperative complications occurred in 44% of patients, and 26% of patients underwent additional surgery for complication management. The most frequent complications were medical complications and extraocular movement deficits. The median preoperative exophthalmos index was 1.26, which improved to 1.12 immediately postoperatively and to 1.09 at the 6-month follow-up (p < 0.001). Postoperatively, 18 patients (33%) underwent adjuvant radiotherapy after subtotal resection. Tumors recurred/progressed in 12 patients (22%).
Resection of hyperostosing sphenoid wing meningiomas, particularly achieving gross-total resection of hyperostotic bone with a good aesthetic result, is challenging and associated with notable medical and ocular morbidity. Recurrence rates in this series are higher than previously reported. Nevertheless, the authors were able to attain improvement in proptosis and visual symptoms in the majority of patients by using a multidisciplinary approach.
蝶骨翼骨膜瘤引起的骨过度生长可延伸至眼眶，导致眼球突出、眼球运动受限和/或压迫性视神经病变。需要切除的骨量以及预防眼球内陷的最佳重建策略存在争议。在此，作者介绍了他们的手术结果和重建结果。
这是对 54 例连续接受蝶骨翼骨膜瘤伴骨过度生长切除术的患者进行的回顾性研究。大多数病例由资深作者手术。分析了肿瘤切除范围、骨切除体积、放射性眼球突出指数、并发症和复发情况。
该队列的中位年龄为 52.1 岁，女性占 83%。眼球突出是 74%的首发症状，52%的患者视力下降。世界卫生组织分级为 I 级（85%）或 II 级（15%）。中位随访时间为 2.6 年。在体积分析中，骨过度生长的 86%被切除。颅内肿瘤的大体全切除率为 43%，眼眶肿瘤的切除率为 27%，颅内和眼眶所有肿瘤成分的切除率为 20%。96%的患者进行了眼眶重建。术后视力稳定或改善的患者占 98%，复视改善的患者占 89%。术后并发症发生在 44%的患者中，26%的患者因并发症管理需要再次手术。最常见的并发症是内科并发症和眼外肌运动障碍。术前眼球突出指数中位数为 1.26，术后即刻改善至 1.12，术后 6 个月随访时改善至 1.09（p<0.001）。术后，18 例（33%）患者在次全切除后接受辅助放疗。12 例（22%）患者肿瘤复发/进展。
蝶骨翼骨膜瘤的切除术，特别是实现骨过度生长的大体全切除并获得良好的美容效果，具有挑战性，且与显著的内科和眼部发病率相关。本研究中的复发率高于先前报道的复发率。然而，作者通过采用多学科方法，使大多数患者的眼球突出和视力症状得到改善。
