Department of Neurosurgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Department of Neurosurgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
J Clin Neurosci. 2024 Nov;129:110837. doi: 10.1016/j.jocn.2024.110837. Epub 2024 Sep 16.
Spheno-orbital meningiomas (SOM) are known to invaded critical skull base areas. The authors report a series of WHO I SOM, propose a subclassification of this tumor according to its extension to critical positions and analyze the impact of extent of resection and the role of stereotactic radiotherapy in tumor recurrence.
A prospective maintained university medical center registry was utilized to undertake a retrospective review of patients operated with WHO I SOM. Details related to critical skull base region's extension (superior orbital fissure, cavernous sinus, orbital apex), extent of resection and adjuvant radiosurgery were collected. Statistical calculations were preformed using IBM SPSS Statistics version 25. A p value < 0.05 was considered significant. Survival analysis was performed using Kaplan-Meier survival analysis and the log rank test.
A total of 77 patients operated from 2002 to 2021 were included. There were 65 women (84.4 %) and 12 men (15.6 %). Mean age at surgery was 54.8 years (median 53 years, range 23 - 88). Tumors were defined as local in 28 (35.4 %) and with extension into the skull base critical structures in 51 (64.6 %). GTR was achieved in 35 (44.3 %), STR in 40 (50.6 %), and PR in four (5.1 %). Surgical morbidity was 10 %. There was no surgical mortality. 28 patients with STR or PR were treated with adjuvant radiotherapy. The total length of follow up was a mean of 172.3 months. There were 14 recurrences/progressive growth (17.7 %), 63 patients (79.7 %) had no recurrence/progressive growth, and two patients (2.5 %) were lost to follow-up. PFS was significant statistically different in patients with invasive tumors in whom the extent of resection was subtotal, with a longer PFS in patients that were treated with adjuvant radiotherapy. (P value < 0.001).
SOM could be divided in two groups according to its skull base extension facilitating decision management and outcome prediction. Patients with local WHO I SOM had higher rate of GTR and better PFS than tumors extending to involve critical regions. When STR or PR is achieved postoperative adjuvant radiotherapy is advised if there is evidence of previous tumor growth.
蝶眶脑膜瘤（SOM）已知侵犯关键颅底区域。作者报告了一系列世界卫生组织 I 级 SOM，并根据肿瘤向关键部位的扩展提出了这种肿瘤的分类，并分析了切除范围和立体定向放疗在肿瘤复发中的作用。
利用前瞻性维持的大学医学中心登记处对接受世界卫生组织 I 级 SOM 手术的患者进行回顾性回顾。收集了与关键颅底区域扩展（眶上裂、海绵窦、眶尖）、切除范围和辅助放射外科手术相关的详细信息。使用 IBM SPSS Statistics 版本 25 进行统计计算。p 值<0.05 被认为具有统计学意义。使用 Kaplan-Meier 生存分析和对数秩检验进行生存分析。
共纳入 2002 年至 2021 年期间手术的 77 例患者。其中 65 例为女性（84.4%），12 例为男性（15.6%）。手术时的平均年龄为 54.8 岁（中位数 53 岁，范围 23-88 岁）。肿瘤被定义为局部 28 例（35.4%），侵犯颅底关键结构 51 例（64.6%）。达到 GTR 者 35 例（44.3%），STR 者 40 例（50.6%），PR 者 4 例（5.1%）。手术发病率为 10%。无手术死亡率。28 例 STR 或 PR 患者接受辅助放疗。总的随访时间平均为 172.3 个月。共有 14 例（17.7%）复发/进展性生长，63 例（79.7%）无复发/进展性生长，2 例（2.5%）失访。在侵犯性肿瘤患者中，肿瘤切除程度不全的患者 PFS 有统计学显著差异，接受辅助放疗的患者 PFS 更长（P 值<0.001）。
根据肿瘤向颅底的扩展情况，SOM 可分为两组，有利于决策管理和预测结果。局部 WHO I 级 SOM 患者的 GTR 率较高，无进展生存期（PFS）优于侵犯关键区域的肿瘤。如果有肿瘤生长的证据，STR 或 PR 后应行术后辅助放疗。
