Spheno-orbital meningiomas surgery: multicenter management study for complex extensive tumors.
World Neurosurg. 2018 Jan 06;:
Authors: Terrier LM, Bernard F, Fournier HD, Morandi X, Velut S, Hénaux PL, Amelot A, François P
Abstract
BACKGROUND: Spheno-orbital meningiomas (SOMs) are complex tumors involving the sphenoid wing, the orbit, and sometimes the cavernous sinus with bone hyperostosis and sheet-like dural involvement. Optimal removal, proptosis cure and visual preservation remain a challenge.
OBJECTIVE: To study the management of surgically treated SOMs METHODS: The clinical records of 130 consecutive patients undergoing surgery for SOMs were retrospectively collected in a database during a 20-year period to analyze symptoms, surgical technique, clinical outcome, and follow-up.
RESULTS: Among the 130 patients (mean age 51.2+/-9.5 years), 91.5% were females. The most typical symptoms recorded were proptosis in 94.6%, visual impairment in 37.7%, and oculomotor paresis in 10.0%. Simpson I-II removal was achieved in 97 patients (74.6%). After 1-year, proptosis was improved in 60% of cases. 44.9% of the patients with preoperative visual acuity impairment were improved. Periorbital excision was statistically linked to proptosis decreasing (p=0.0001) and optic canal decompression was linked to visual stabilization (p=0.03). Bone reconstruction prevented temporal muscle atrophy (p=0.01) and unaesthetic results (p=0.0001). Mean follow-up was 76.5 months (range 3-288 months) and the mean time for recurrence was 54.2 months.
CONCLUSIONS: A single-stage optimal surgery with bone reconstruction appears to be the best first-line treatment, on a case-by-case analysis. Optic canal decompression and periorbital excision have to be performed in case of visual disturbance and proptosis. SOMs require a long-term follow-up because of a delayed high rate of recurrence.
PMID: 29317363 [PubMed - as supplied by publisher]
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