1Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland.
2Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland; and.
J Neurosurg. 2023 Nov 17;140(5):1305-1311. doi: 10.3171/2023.8.JNS23305. Print 2024 May 1.
The objective of this study was to evaluate the effect of reconstruction and orbital volume on the reduction of proptosis in patients undergoing resection for spheno-orbital meningiomas. Additionally, potential predictors of optimal proptosis reduction after surgery were evaluated.
Patients with spheno-orbital meningiomas who underwent resection at the authors' institution between 2005 and 2020 were evaluated retrospectively. The exophthalmos index (EI) was measured on pre- and postoperative imaging to quantify proptosis and calculate the primary outcome measure of proptosis reduction. Patients were excluded if they had no preoperative proptosis (i.e., EI < 1.1), prior resection, or insufficient imaging available for analysis. Clinical and surgical characteristics were collected, including sex, extent of resection, WHO grade, and rigid orbital reconstruction, and assessed as predictors of greater proptosis reduction. Additionally, orbital volumes of the affected and contralateral orbits were measured to correlate postoperative orbital volumes with proptosis reduction.
Thirty-three patients, with a mean age of 53 years, met inclusion criteria. The majority of the patients were female (23, 69.7%), and most tumors were classified as WHO grade 1 (29, 87.9%). Six patients (18.2%) underwent rigid orbital reconstruction. The mean EI across all patients decreased from 1.36 ± 0.18 to 1.19 ± 0.15 (p < 0.001). Patients who underwent reconstruction had on average a 76.4% greater reduction in the EI (p = 0.036) and a 9.1 times higher odds of achieving a normal EI (< 1.1) compared with those who did not receive reconstruction (OR 9.1, p = 0.025). Additionally, patients without residual hyperostotic bone compressing the orbit had a 2.16 times greater reduction in EI (p = 0.039). A linear relationship between orbital volume ratios (affected/unaffected orbit) and proptosis reduction was observed (p = 0.029, r = 0.529), including at ratios > 1.0. This suggests that greater orbital volumes postoperatively correlated with greater reductions in proptosis.
Three factors were identified that optimize proptosis correction. First, all abnormal bone compressing the orbital contents must be removed completely. Second, rigid orbital reconstruction leads to improved proptosis correction, possibly by preventing frontal lobe and dural reconstruction from descending onto the compressed orbit. Third, aiming for an orbital volume slightly larger than the contralateral normal side leads to improved proptosis correction.
本研究旨在评估眼眶重建和眶容积对蝶眶脑膜瘤切除术患者眼球突出度改善的影响，并评估术后眼球突出度最佳改善的潜在预测因素。
回顾性分析 2005 年至 2020 年间在作者所在机构行蝶眶脑膜瘤切除术的患者。术前和术后影像学检查测量眼球突出度指数（EI）以量化眼球突出度，并计算眼球突出度改善的主要指标。如果患者术前无眼球突出（即 EI<1.1）、有既往切除术史或影像学资料不足，则将其排除在外。收集患者的临床和手术特征，包括性别、切除范围、世界卫生组织（WHO）分级和硬性眼眶重建，并评估其作为改善眼球突出度的预测因素。此外，还测量了受累侧和对侧眼眶容积，以将术后眼眶容积与眼球突出度改善相关联。
符合纳入标准的患者共 33 例，平均年龄为 53 岁。大多数患者为女性（23 例，69.7%），大多数肿瘤为 WHO 分级 1 级（29 例，87.9%）。6 例（18.2%）患者行硬性眼眶重建。所有患者的平均 EI 从 1.36±0.18 降至 1.19±0.15（p<0.001）。行重建术的患者 EI 平均改善幅度增加 76.4%（p=0.036），且术后 EI 正常（<1.1）的可能性增加 9.1 倍（OR 9.1，p=0.025）。此外，对于未残留压迫眶内容物的骨质增生的患者，EI 改善幅度增加 2.16 倍（p=0.039）。观察到眼眶容积比（患侧/健侧）与眼球突出度改善之间存在线性关系（p=0.029，r=0.529），包括容积比>1.0 的情况。这表明术后眼眶容积越大，眼球突出度改善幅度越大。
本研究确定了三个可优化眼球突出矫正效果的因素。首先，必须彻底清除所有压迫眶内容物的异常骨质。其次，硬性眼眶重建可改善眼球突出矫正效果，其可能机制为防止额叶和硬脑膜重建物向受压的眶内下降。第三，目标眶容积略大于健侧正常眶容积可改善眼球突出矫正效果。
