1Department of Neurosurgery, CHRU de Tours, France.
2Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, Marseille, France.
J Neurosurg. 2024 Apr 19;141(3):702-710. doi: 10.3171/2024.1.JNS232406. Print 2024 Sep 1.
Bilateral spheno-orbital meningiomas (bSOMs) are a rare entity among meningiomas. These tumors are benign and predominantly affect women. They represent 4% of spheno-orbital meningiomas (SOMs) and are poorly described in the literature. This study aimed to describe the characteristics, risk factors, evolution, and management of bSOMs.
Twenty patients with bSOMs were enrolled in a multicentric descriptive study including 15 neurosurgical departments.
In this study, the authors found that bSOMs affected exclusively women, with a mean age of 50 years. Approximately 65% of patients were on progestin therapy. The mean follow-up in this series was 55 months. Clinically, visual symptoms were predominant: proptosis was present in 17 of 20 patients (85%; 7 unilateral, 10 bilateral), and a decrease in visual acuity was observed in 11 of 20 patients (55%; 6/10 to 9/10 in 6 patients, 3/10 to 5/10 in 1 patient, and < 3/10 in 4 patients). Contrary to unilateral SOMs, the authors identified that intracranial hypertension was a common presentation (25%) of bSOMs. Surgical management with gross-total resection was the gold standard treatment. Recurrences only occurred following subtotal resection in 36% to 60% of patients, with a median time of 50 to 54 months after surgery. Visual improvement or stability was observed in 75% of cases postoperatively. Progesterone receptor expression levels were 70% to 100% in 10 of 11 (91%) cases.
Bilateral SOMs are usually found in female patients and are strongly associated with hormone replacement therapy. Early surgical management with gross-total resection is the most effective treatment in terms of recurrence and improves visual acuity. Given the slow progressive nature of bSOMs and their time to recurrence, which can be up to 10 years, long-term follow-up of patients is essential.
双侧蝶眶脑膜瘤（bSOM）是脑膜瘤中一种罕见的实体瘤。这些肿瘤为良性，主要影响女性。它们占蝶眶脑膜瘤（SOM）的 4%，在文献中描述较少。本研究旨在描述 bSOM 的特征、风险因素、演变和治疗。
20 例 bSOM 患者纳入一项多中心描述性研究，包括 15 个神经外科科室。
在这项研究中，作者发现 bSOM 仅影响女性，平均年龄为 50 岁。约 65%的患者正在接受孕激素治疗。本系列的平均随访时间为 55 个月。临床症状主要为视觉症状：20 例患者中有 17 例（85%；7 例单侧，10 例双侧）存在眼球突出，20 例患者中有 11 例（55%）视力下降：6 例患者视力从 6/10 提高到 9/10，1 例患者从 3/10 下降到 5/10，4 例患者视力低于 3/10。与单侧 SOM 不同，作者发现颅内压增高是 bSOM 的常见表现（25%）。全切除手术是治疗的金标准。在 36%至 60%的患者中，仅在次全切除后复发，术后中位时间为 50 至 54 个月。75%的患者术后视力得到改善或稳定。在 11 例患者中有 10 例（91%）孕激素受体表达水平为 70%至 100%。
双侧 SOM 通常发生在女性患者中，与激素替代疗法密切相关。早期手术治疗，采用全切除手术，在复发和提高视力方面是最有效的治疗方法。鉴于 bSOM 的缓慢进展性质及其复发时间，最长可达 10 年，因此对患者进行长期随访至关重要。
