Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Oper Neurosurg (Hagerstown). 2024 Sep 1;27(3):370-374. doi: 10.1227/ons.0000000000001156. Epub 2024 Apr 17.
Spheno-orbital meningiomas (SOMs) pose a challenge to the skull base neurosurgeon because of their variable presentation and involvement of critical structures within the orbit. There is no consensus on optimal management of these patients and how to achieve maximal safe resection. The authors share an illustrative case with an accompanying video to demonstrate their aggressive approach to resect SOMs and their intraorbital components.
A 75-year-old-woman presented with progressive vision loss and proptosis. Magnetic resonance imaging was consistent with a large, left-sided sphenoid wing meningioma with extension to the orbital wall and compression of the optic nerve medially. The patient elected to undergo surgical excision and optic nerve decompression. She did well postoperatively with resolution of proptosis and good resection margins on follow-up imaging.
Aggressive resection of SOMs is possible with an understanding of the underlying anatomy. Familiarity with the orbit can facilitate a maximal safe resection with optic nerve decompression.
由于蝶眶脑膜瘤（SOM）的表现形式多样，且涉及眼眶内的关键结构，因此给颅底神经外科医生带来了挑战。目前，对于这些患者的最佳治疗方法以及如何实现最大程度的安全切除，尚无共识。作者分享了一个伴有视频的典型病例，以展示他们对 SOM 和其眶内成分进行积极切除的方法。
一位 75 岁女性因进行性视力下降和眼球突出就诊。磁共振成像显示左侧蝶骨翼大脑膜瘤，延伸至眶壁并向内侧压迫视神经。患者选择接受手术切除和视神经减压。术后患者恢复良好，眼球突出缓解，随访影像学检查显示肿瘤切除充分。
通过了解相关解剖结构，可以对 SOM 进行积极切除。熟悉眼眶解剖结构有助于在视神经减压的同时进行最大限度的安全切除。
