Dos Santos Alexandra Gomes, Paiva Wellingson Silva, da Roz Leila Maria, Santo Marcelo Prudente do Espirito, Teixeira Manoel Jacobsen, Figueiredo Eberval G, da Silva Vinicius Trindade Gomes
Division of Neurosurgery, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Surg Neurol Int. 2022 Jul 22;13:318. doi: 10.25259/SNI_165_2022. eCollection 2022.
Meningiomas correspond to one-third of all primary central nervous system tumors. Approximately 9% of them are spheno-orbital meningiomas (SOMs), presenting significant clinical symptoms as visual impairment and orbital esthetics. This article aims to evaluate exophthalmos' improvement in a surgical series without orbital reconstruction.
We consecutively included all patients diagnosed with SOM, admitted to a single institution for 10 years. Surgical resection was the standard of care, associated or not with adjuvant radiation therapy. The radiological investigation included preoperative and postoperative head CT or MRI. We quantified proptosis through imaging.
Forty patients composed this series, 87.5% were female. Proptosis was the most common presentation (90%), followed by decreased visual acuity (65%), motility deficit (20%), and headache (20%). Gross total resection was achieved in 65% of the procedures. In late outcomes, 78% of the patients maintained or improved visual acuity and 85% maintained or improved headache. Proptosis significantly improved after surgery and along with the follow-up ( < 0.001). Ten patients were submitted to adjuvant RT, six of them after a subtotal resection. All patients of this subgroup had proptosis. It was observed a higher frequency of worse in visual acuity in patients submitted to RT (71% vs. 28%, = 0.038).
Resection of SOM was sufficient to stop the evolution of visual deficit and allowed the improvement of proptosis. Orbital reconstruction does not seem to be an essential step in reducing enophthalmos.
脑膜瘤占所有原发性中枢神经系统肿瘤的三分之一。其中约9%为蝶骨嵴脑膜瘤（SOM），可出现视力损害和眼眶美观等显著临床症状。本文旨在评估一组未进行眼眶重建手术的患者眼球突出度的改善情况。
我们连续纳入了在单一机构就诊10年的所有诊断为SOM的患者。手术切除是标准治疗方法，可联合或不联合辅助放疗。影像学检查包括术前和术后头部CT或MRI。我们通过影像学对眼球突出度进行量化。
本系列共40例患者，87.5%为女性。眼球突出是最常见的表现（90%），其次是视力下降（65%）、眼球运动障碍（20%）和头痛（20%）。65%的手术实现了肿瘤全切除。在远期结果中，78%的患者视力维持或改善，85%的患者头痛维持或改善。手术后及随访期间眼球突出度显著改善（<0.001）。10例患者接受了辅助放疗，其中6例在次全切除后进行。该亚组所有患者均有眼球突出。接受放疗的患者视力恶化的频率更高（71%对28%，P = 0.038）。
切除SOM足以阻止视力缺陷的进展并使眼球突出度得到改善。眼眶重建似乎不是减少眼球内陷的必要步骤。
