Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA.
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Acta Neurochir (Wien). 2024 Feb 28;166(1):113. doi: 10.1007/s00701-024-05979-2.
Spheno-orbital meningiomas (SOMs) represent a distinct subtype of meningioma characterized by their unique multi-compartmental invasion pattern. Previous studies have investigated correlations between SOMs and visual manifestations. However, our comprehension of pain associated with SOMs remains limited. This study aims to provide insight into the pathophysiology underlying SOM-related pain through measurements of tumor volume and superior orbital fissure (SOF) narrowing.
This retrospective study included patients who underwent surgical resection of a SOM between 2000 and 2022. Preoperative CT and/or MRI scans were analyzed, and the tumor volume of each segment was measured. Bony 3D reconstructions were used to measure the area of the SOF, and SOF narrowing was calculated.
The study cohort included 66 patients diagnosed with SOMs, among which 25.8% (n = 17) presented with pain. Postoperatively, 14/17 (82.4%) of patients reported pain improvement. There was no significant correlation between the total volume or the volume of tumor within each compartment and the presence of pain on presentation (p > 0.05). The median SOF narrowing was significantly different between patients presenting with and without tumor-associated pain with median of 11 mm (IQR 2.8-22.3) and 2 mm (IQR 0-6), respectively (p = 0.005). Using logistic regression, a significant correlation between the degree of SOF narrowing and the presence of SOM-associated pain on presentation was identified, with an aOR of 1.2 (95% CI 1.12-1.3, p = 0.02).
While the exact cause of tumor-associated pain remains unclear, SOF narrowing seems to play a role in pain among SOM patients. Based on the radiological characteristics, SOF neurovascular decompression is recommended in SOM patients.
蝶眶脑膜瘤（SOM）是脑膜瘤的一种特殊亚型，其特征为独特的多腔室侵犯模式。先前的研究已经探讨了 SOM 与视觉表现之间的相关性。然而，我们对 SOM 相关疼痛的认识仍然有限。本研究旨在通过测量肿瘤体积和眶上裂（SOF）狭窄程度，深入了解 SOM 相关疼痛的病理生理学。
这是一项回顾性研究，纳入了 2000 年至 2022 年间接受 SOM 手术切除的患者。分析了术前 CT 和/或 MRI 扫描，并测量了每个节段的肿瘤体积。使用骨 3D 重建来测量 SOF 的面积，并计算 SOF 狭窄程度。
该研究队列包括 66 例 SOM 患者，其中 25.8%（n=17）出现疼痛。术后，17 例患者中有 14 例（82.4%）报告疼痛改善。总肿瘤体积或每个节段肿瘤体积与就诊时疼痛的存在之间无显著相关性（p>0.05）。伴或不伴肿瘤相关疼痛的患者的 SOF 狭窄中位数存在显著差异，分别为 11mm（IQR 2.8-22.3）和 2mm（IQR 0-6）（p=0.005）。使用逻辑回归，发现 SOF 狭窄程度与 SOM 相关疼痛的存在之间存在显著相关性，OR 值为 1.2（95%CI 1.12-1.3，p=0.02）。
尽管肿瘤相关疼痛的确切原因尚不清楚，但 SOF 狭窄似乎在 SOM 患者的疼痛中起作用。根据影像学特征，建议对 SOM 患者进行 SOF 神经血管减压术。
