Mariniello Giuseppe, Corvino Sergio, Corazzelli Giuseppe, de Divitiis Oreste, Fusco Giancarlo, Iuliano Adriana, Strianese Diego, Briganti Francesco, Elefante Andrea
Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, School of Medicine, University of Naples "Federico II", 80131 Naples, Italy.
Department of Advanced Biomedical Sciences, School of Medicine, University of Naples "Federico II", 80131 Naples, Italy.
Cancers (Basel). 2024 Jun 5;16(11):2148. doi: 10.3390/cancers16112148.
Surgery stands as the primary treatment for spheno-orbital meningiomas, following a symptoms-oriented approach. We discussed the decision-making process behind surgical strategies through a review of medical records from 80 patients who underwent surgical resection at the University of Naples Federico II. Different surgical approaches were employed based on the tumor's location relative to the optic nerve's long axis, categorized into lateral (type I), medial (type II), and diffuse (type III). We examined clinical, neuroradiological, surgical, pathological, and outcome factors. Proptosis emerged as the most frequent symptom (97%), followed by visual impairment (59%) and ocular motility issues (35%). Type I represented 20%, type II 43%, and type III 17%. Growth primarily affected the optic canal (74%), superior orbital fissure (65%), anterior clinoid (60%), and orbital apex (59%). The resection outcomes varied, with Simpson grades I and II achieved in all type I cases, 67.5% of type II, and 18% of type III. Recurrence rates were highest in type II (41.8%) and type III (59%). Improvement was notable in proptosis (68%) and visual function (51%, predominantly type I). Surgery for spheno-orbital meningiomas should be tailored to each patient, considering individual characteristics and tumor features to improve quality of life by addressing primary symptoms like proptosis and visual deficits.
手术是蝶眶脑膜瘤的主要治疗方法，遵循以症状为导向的方法。我们通过回顾那不勒斯费德里科二世大学80例接受手术切除患者的病历，讨论了手术策略背后的决策过程。根据肿瘤相对于视神经长轴的位置采用不同的手术入路，分为外侧（I型）、内侧（II型）和弥漫型（III型）。我们研究了临床、神经放射学、手术、病理和预后因素。眼球突出是最常见的症状（97%），其次是视力障碍（59%）和眼球运动问题（35%）。I型占20%，II型占43%，III型占17%。肿瘤生长主要累及视神经管（74%）、眶上裂（65%）、前床突（60%）和眶尖（59%）。切除结果各不相同，所有I型病例均达到辛普森I级和II级，II型为67.5%，III型为18%。复发率在II型（41.8%）和III型（59%）中最高。眼球突出（68%）和视觉功能（51%，主要是I型）有明显改善。蝶眶脑膜瘤的手术应根据每位患者的情况进行定制，考虑个体特征和肿瘤特点，通过解决眼球突出和视觉缺陷等主要症状来提高生活质量。
