Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Kangnam-ku, Seoul, 06351, South Korea.
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Graefes Arch Clin Exp Ophthalmol. 2021 Apr;259(4):1015-1024. doi: 10.1007/s00417-020-05008-9. Epub 2020 Nov 23.
This study was aimed at evaluating the orbital decompressive effect of endoscopic transorbital approach (TOA) in the management of sphenoorbital meningioma involving the orbit.
Patients treated with TOA for this tumor from December 2016 to December 2019 were included, and the data were reviewed. Pre- and postoperative clinical and imaging findings were compared with a volumetric study.
Eighteen patients (two men and 16 women) were included. Lateral wall hyperostosis (13 patients), extraconal tumor infiltration (18 patients), intraconal tumor infiltration (seven patients), and superior and lateral rectus encasement (nine patients) were found. Intraconal tumor infiltration in the posterior orbit affected compressive optic neuropathy (CON) more often than other tumor manifestations. The orbital soft tissue volume decreased to 91.18% ± 8.19% compared to that in the contralateral side preoperatively. The postoperative volume increased to 113.73% ± 12.92% compared to the preoperative volume. The average values of LogMAR visual acuity and visual field index score of ten patients with CON improved from 0.80 to 0.42 and 48.9 to 65.9%, respectively. All 17 patients with proptosis showed improvement after surgery. There were no significant complications associated with the surgery. Additional treatment, including gamma knife surgery, was applied to 12 cases for the remaining tumor.
This minimally invasive surgical debulking procedure was successful in treating sphenoorbital meningioma without significant adverse events. Lateral orbital wall decompression and limited intraorbital tumor resection were effective for compressive orbitopathy from the tumor.
本研究旨在评估内镜经眶入路（TOA）在治疗累及眼眶的蝶眶脑膜瘤中的眶减压效果。
纳入 2016 年 12 月至 2019 年 12 月期间采用 TOA 治疗该肿瘤的患者，并对其数据进行回顾性分析。比较了术前和术后的临床和影像学发现，并进行了体积研究。
共纳入 18 例患者（2 例男性，16 例女性）。发现外侧壁骨肥厚（13 例）、眶外肿瘤浸润（18 例）、眶内肿瘤浸润（7 例）和上、外直肌包裹（9 例）。后眶内肿瘤浸润较其他肿瘤表现更常引起压迫性视神经病变（CON）。与对侧相比，眼眶软组织体积术前减少至 91.18%±8.19%，术后增加至 113.73%±12.92%。10 例 CON 患者的 LogMAR 视力和视野指数评分的平均值分别从 0.80 提高至 0.42 和从 48.9 提高至 65.9%。所有 17 例眼球突出患者术后均有改善。手术无明显并发症。对于 12 例剩余肿瘤，还应用伽玛刀手术等辅助治疗。
这种微创的手术去瘤方法成功治疗了蝶眶脑膜瘤，无明显不良事件。外侧眶壁减压和有限的眶内肿瘤切除对于肿瘤引起的压迫性眶病是有效的。
