Zusammenfassung
Hintergrund
Im Rahmen dieser Studie sollte in einer großen chirurgischen Serie das Wachstumsverhalten sphenoorbitaler Meningeome untersucht werden.
Patienten und Methoden
Es wurden 77 Patienten (davon 61 Frauen) mit sphenoorbitalen Meningeomen, die zwischen 1991 und 2009 operiert wurden, retrospektiv untersucht. Der Standardzugang beinhaltet eine pterionale Kraniotomie, extradurale Resektion des infiltrierten Knochens, intradurale und orbitale Tumorentfernung mit Rekonstruktion der Dura und partiell das lateralen Knochens. Die Nachbeobachtungszeit variierte zwischen 6 und 130 Monaten (Mittelwert 57,9 Monate).
Ergebnisse
Eine komplette Resektion konnte bei 42 Patienten erreicht werden, 58 Meningeome zeigten eine Beteiligung des Orbitadachs und/oder der lateralen Orbitawand, 42 betrafen den extrakonalen Raum und 11 den intrakonalen Raum; 63 Tumore involvierten die Fissura orbitalis superior, 54 den Optikuskanal und 24 die Fissura orbitalis inferior; 17 Tumore infiltrierten den Sinus cavernosus und 37 den vorderen Klinoidfortsatz. Der Eingriff ist mit einer Morbiditätsrate von 14,3% (geringe Defizite), bzw. 4% (ausgeprägte Defizite) behaftet. Subtotale Resektionen wurden bei 35 Patienten aufgrund intraorbitalen Tumorwachstums (n=8), Tumor im Sinus cavernosus (n=12), Tumorinfiltration der Fissura orbitalis superior (n=12) und Infiltration der Schädelbasis (n=3) durchgeführt. Neun Patienten wurden postoperativ nachbestrahlt (3-dimensionale Konformationsbestrahlung), worunter bei 8 Patienten ein stabiles Tumorvolumen erzielt werden konnte. Rezidive traten bei 10 Patienten (12,9%) nach der Operation während eines Nachbeobachtungszeitraumes von 10–47 Monaten auf.
Schlussfolgerung
Das Ziel der Operation sollte die komplette Tumorentfernung ohne Morbidität sein. Eine genaue Analyse des Tumorwachstums und der Infiltration der Strukturen ist zur Operationsplanung zwingend erforderlich.
Abstract
Background
The purpose of this study was to present the findings on growth patterns in a large surgical series of sphenoorbital meningiomas.
Patients and methods
A retrospective analysis was performed on 77 patients (61 f) harboring sphenoorbital meningiomas, who underwent surgery between 1991 and 2009. The standard surgical approach consisted of pterional craniotomy and extradural resection of any infiltrated bone. The intradural and orbital tumor was resected, with complete reconstruction of the dura while the lateral bone was partially reconstructed. The follow-up period ranged from 6 to 130 months (mean: 57.9 months).
Results
Total macroscopic resection was achieved in 42 patients. Fifty-eight meningiomas extended to the orbital roof and/or lateral orbital wall, 42 involved the extraconal space, and 11 the intraconal space. Sixty-three tumors involved the superior orbital fissure, 54 the optic canal, and 24 the inferior orbital fissure. Seventeen tumors infiltrated the cavernous sinus and 37 involved the anterior clinoid process. The rate of minor morbidity was 14.3% (slight deficits) and the rate of major morbidity was 4% (significant deficits). Subtotal resections were performed on 35 patients because there was intraorbital tumor (n=8); tumor in the cavernous sinus (n=12); tumor invading the superior orbital fissure (n=12); and tumor of the skull base (n=3). Nine patients underwent postoperative three-dimensional conformal radiotherapy, which resulted in stable tumor volume at follow-up in eight patients. Tumor recurrence was identified in ten patients (12.9%) postoperatively (range of follow-up: 10–47 months).
Conclusion
The goal of surgery is complete tumor removal without morbidity. Exact analysis of tumor growth and possible involvement of pertinent structures are mandatory in planning the procedure.
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Schick, U. Sphenoorbitale Meningeome. HNO 58, 37–43 (2010). https://doi.org/10.1007/s00106-009-2024-y
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DOI: https://doi.org/10.1007/s00106-009-2024-y