Lasunin Nikolay, Cherekaev Vasiliy, Abdullaev Abdulla, Gadzhiagaev Vadim, Danilov Gleb, Strunina Yulia, Golbin Denis, Okishev Dmitriy
Burdenko National Medical Research Center for Neurosurgery, Moscow, Russian Federation.
Neurosurg Rev. 2023 Oct 13;46(1):268. doi: 10.1007/s10143-023-02178-y.
Following meningioma removal, there are numerous methods available for reconstructing the orbital wall. This systematic review seeks to summarize the published data on the surgical treatment of cranioorbital meningiomas, and to analyze the effectiveness and safety of various techniques and materials used for the reconstruction of bony orbital walls. We conducted a search of the two databases and included original articles with a series of 10 or more cases. Descriptive statistics and meta-analysis of individual patient date were performed. The analysis included a total of 858 patients from 29 sources. No reconstruction of the orbital walls was performed in 525 patients (61.2%), while 333 observations (38.8%) involved resection followed by reconstruction. A relative improvement in eye position was achieved in 94.4% of cases with a 95% CI of (88.92%; 97.25%). However, normalization of eye position, regardless of reconstruction technique, was only present in 6.22% of cases with a 95% CI of (1.24%; 25.9%). The best results were observed with the use of autologous bone implants (64%, 95% CI [33.35%; 86.33%]) and titanium implants (55.78%, 95% CI [2.86%; 98.18%]). In cases of endoscopic resection and microsurgical resection without reconstruction, symmetrical eye position accounted for only 1.94% (95% CI [0%; 96.71%]) and 2.35% (95% CI [0.13%; 31.23%]), respectively. The frequency of normalization of eye position differed significantly (p < 0.01) among the subgroups. A total of 49 postoperative complications were registered, with wound infection (1.52%, 95% CI [0.86%; 2.65%]) and wound cerebrospinal fluid leak (1.32%, 95% CI [0.6%; 2.91%]) being the most frequent. No significant differences were found in the rates of complications among the different subgroups. One of the primary objectives of cranioorbital meningioma surgery is to correct the position of the eye. Simultaneous reconstruction of the bony orbital leads to better cosmetic outcomes. Postoperative complications did not depend on the reconstructive technique or the materials.
脑膜瘤切除术后，有多种方法可用于重建眶壁。本系统评价旨在总结已发表的关于颅眶脑膜瘤外科治疗的数据，并分析用于重建眶骨壁的各种技术和材料的有效性和安全性。我们检索了两个数据库，并纳入了一系列10例或更多病例的原始文章。对个体患者数据进行描述性统计和荟萃分析。分析共纳入了来自29个来源的858例患者。525例患者（61.2%）未进行眶壁重建，而333例观察（38.8%）涉及切除后重建。94.4%的病例实现了眼球位置的相对改善，95%置信区间为（88.92%；97.25%）。然而，无论采用何种重建技术，眼球位置正常化的病例仅占6.22%，95%置信区间为（1.24%；25.9%）。使用自体骨植入物（64%，95%置信区间[33.35%；86.33%]）和钛植入物（55.78%，95%置信区间[2.86%；98.18%]）观察到的效果最佳。在内镜切除和未进行重建的显微手术切除病例中，眼球位置对称分别仅占1.94%（95%置信区间[0%；96.71%]）和2.35%（95%置信区间[0.13%；31.23%]）。各亚组中眼球位置正常化的频率差异显著（p < 0.01）。共记录到49例术后并发症，其中伤口感染（1.52%，95%置信区间[0.86%；2.65%]）和伤口脑脊液漏（1.32%，95%置信区间[0.6%；2.91%]）最为常见。不同亚组之间的并发症发生率未发现显著差异。颅眶脑膜瘤手术的主要目标之一是纠正眼球位置。同时重建眶骨可带来更好的美容效果。术后并发症不取决于重建技术或材料。
