Guedes Breno W M, de Souza Júnior Joilson F, D'Avila Melo Nelson A, de Menezes Neto João M B, Beer-Furlan André, Oliveira Arthur M P
Departments of1Neurosurgery and.
2Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil; and.
J Neurosurg Case Lessons. 2022 Sep 5;4(10). doi: 10.3171/CASE22267.
Meningiomas are the most frequent primary tumors in the central nervous system (CNS), but intraorbital location is uncommon and accounts for only 0.2% to 4% of all CNS meningiomas. Lesions in this compartment could be classified as primary, secondary, or ectopic. The close relationship with the optic nerve sheath is a landmark to identify the tumor as primary, whereas secondary tumors commonly come from an extension of an intracranial meningioma, and ectopic meningioma is a concept not yet completely established.
The authors present a rare case of a secondary intraorbital meningioma operated through an endoscopic endonasal approach. Secondary meningiomas at the medial orbit are very uncommon, given their more common superior and lateral location as an extension of sphenoid meningiomas. The endoscopic endonasal route provides direct access to the medial orbit. The authors present an illustrative case of a meningioma located at the medial orbit and resected through an endoscopic endonasal approach that provided excellent visualization and anatomical exposure. Additionally, the authors review the concept and possible similarities between secondary and ectopic intraorbital meningiomas.
An endoscopic endonasal approach should be considered as a feasible treatment option for intraorbital meningiomas, especially if they are in the medial orbital wall.
脑膜瘤是中枢神经系统（CNS）最常见的原发性肿瘤，但眶内定位并不常见，仅占所有CNS脑膜瘤的0.2%至4%。该区域的病变可分为原发性、继发性或异位性。与视神经鞘的密切关系是将肿瘤识别为原发性的一个标志，而继发性肿瘤通常来自颅内脑膜瘤的扩展，而异位脑膜瘤是一个尚未完全确立的概念。
作者报告了一例通过鼻内镜经鼻入路手术的罕见眶内继发性脑膜瘤病例。眶内侧的继发性脑膜瘤非常罕见，因为它们更常见于作为蝶骨脑膜瘤扩展的眶上和眶外侧位置。鼻内镜经鼻入路可直接进入眶内侧。作者展示了一例位于眶内侧的脑膜瘤病例，通过鼻内镜经鼻入路切除，提供了极佳的视野和解剖暴露。此外，作者回顾了眶内继发性和异位性脑膜瘤之间的概念及可能的相似之处。
鼻内镜经鼻入路应被视为眶内脑膜瘤的一种可行治疗选择，特别是当它们位于眶内侧壁时。
