Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain.
Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy.
World Neurosurg. 2023 Aug;176:43-59. doi: 10.1016/j.wneu.2023.03.126. Epub 2023 Apr 5.
The endoscopic transorbital approach (ETOA) is a minimally invasive approach that could be particularly appropriate for management of spheno-orbital meningiomas. The aim of this study was to perform a systematic review of the literature on the management of spheno-orbital meningiomas via the minimally invasive ETOA, searching for clinical scenarios in which this approach could be best indicated. A secondary aim was to describe 4 illustrative cases.
A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data including patient demographics, tumor features, and surgical and postoperative outcomes were collected. Cases from our initial experience with ETOA were included in the data.
Data of 58 patients from 9 selected records and from our surgical series were collected. Subtotal, near-total, and gross total resection rates were 44.8%, 10.3%, and 32.7%, respectively. Symptom improvement after surgery was 100% for proptosis, 93% for visual impairment, and 87% for ophthalmoplegia. The most common postoperative complications were transient ophthalmoplegia and maxillary nerve hypoesthesia. Cerebrospinal fluid leak was reported in 2 patients.
Our findings support the use of the ETOA for management of spheno-orbital meningiomas, particularly in at least 3 clinical scenarios: 1) when predominant hyperostotic bone is present; 2) when a globular tumor not showing excessive medial or inferior infiltration is being treated; 3) as part of a multistage treatment for diffuse lesions.
经眶上锁孔入路（ETOA）是一种微创入路，特别适用于蝶眶脑膜瘤的治疗。本研究旨在对经微创 ETOA 治疗蝶眶脑膜瘤的文献进行系统回顾，寻找该方法最适用的临床情况。次要目的是描述 4 个典型病例。
按照系统评价和荟萃分析的首选报告项目进行系统回顾。收集的数据包括患者的人口统计学、肿瘤特征以及手术和术后结果。我们最初的 ETOA 经验中的病例也包括在数据中。
从 9 项选定记录和我们的手术系列中收集了 58 名患者的数据。次全切除、近全切除和大体全切除的比率分别为 44.8%、10.3%和 32.7%。术后症状改善率为：眼球突出 100%，视力障碍 93%，眼肌麻痹 87%。最常见的术后并发症是短暂性眼肌麻痹和上颌神经感觉减退。有 2 例患者出现脑脊液漏。
我们的研究结果支持 ETOA 用于蝶眶脑膜瘤的治疗，尤其是在至少 3 种临床情况下：1）存在主要的骨质过度增生时；2）治疗球形肿瘤且无明显内侧或下侧浸润时；3）作为弥漫性病变多阶段治疗的一部分。
