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McCulley TJ, Aakalu VK, Foster JA, Freitag SK, Dagi Glass LR, Grob SR, Tao JP, Vagefi MR, Yen MT, Yoon MK, Kim SJ, Wladis EJ. Intraoperative Image Guidance in Orbital and Lacrimal Surgery: A Report by the American Academy of Ophthalmology. Ophthalmology 2024:S0161-6420(24)00307-5. [PMID: 38912980 DOI: 10.1016/j.ophtha.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 06/25/2024] Open
Abstract
PURPOSE To review the efficacy and safety of the use of intraoperative image guidance (IIG) in orbital and lacrimal surgery. METHODS A literature search of the PubMed database was last conducted in November 2023 for English-language original research that assessed the use of any image guidance system in orbital and lacrimal surgery that included at least 5 patients. The search identified 524 articles; 94 were selected for full-text analysis by the panel. A total of 32 studies met inclusion criteria. The panel methodologist assigned a level II rating to 2 studies and a level III rating to 30 studies. No study met the criteria for level I evidence. RESULTS Procedures reported on were as follows: fracture repair (n = 14), neoplasm and infiltrate biopsy or excision (n = 6), orbital decompression for Graves ophthalmopathy (n = 3), dacryocystorhinostomy (n = 1), and mixed etiology and procedures (n = 8). Four studies used more than one IIG system. One study that met level II evidence criteria compared the outcomes of orbital fracture repair with IIG (n = 29) and without IIG (n = 29). Borderline better outcomes were reported in the IIG group: 2% versus 10% with diplopia (P = 0.039) and 3% versus 10% with enophthalmos (P = 0.065). The other level II study compared the repair of fractures with navigation (n = 20) and without (n = 20). The group in which navigation was used had a measured mean volume reduction of 3.82 cm3 compared with 3.33 cm3 (P = 0.02), and there was a greater measured reduction in enophthalmos in the navigation group of 0.72 mm (P = 0.001). Although the remaining 30 assessed articles failed to meet level II criteria, all alleged a benefit from IIG. No complications were reported. CONCLUSIONS A small number of comparative studies suggest that there are improved outcomes when IIG is used in orbital fracture repair, but each study suffers from various limitations. No high-quality comparative studies exist for the management of lacrimal surgery, neoplastic disease, or decompression. Complications attributable to the use of IIG have not been identified, and IIG has not been analyzed for cost savings. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Timothy J McCulley
- Department of Ophthalmology, John P. McGovern Medical School, University of Texas Health Science Center, Houston, Texas
| | - Vinay K Aakalu
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Jill A Foster
- Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio; The Ohio State University, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - Suzanne K Freitag
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Lora R Dagi Glass
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Seanna R Grob
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Jeremiah P Tao
- Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, Irvine, California
| | - M Reza Vagefi
- Tufts University School of Medicine, Boston, Massachusetts
| | - Michael T Yen
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Michael K Yoon
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Edward J Wladis
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical Center, Albany (Slingerlands), New York
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Zohdy YM, Jacob F, Agam M, Alawieh A, Bray D, Barbero JMR, Argaw SA, Maldonado J, Rodas A, Sudhakar V, Porto E, Peragallo JH, Olson JJ, Pradilla G, Garzon-Muvdi T. Volumetric Analysis of Spheno-Orbital Meningiomas: Prognostic Correlation and a Compartmentalized Approach. Neurosurgery 2024; 94:736-744. [PMID: 37931131 DOI: 10.1227/neu.0000000000002724] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/24/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Spheno-orbital meningiomas arise from the arachnoid villi cap cells at the sphenoid ridge and have the ability to spread through soft tissue extension and cranial bone invasion. Owing to their orbital hyperostosis and intraorbital soft tissue extension, they commonly present with ophthalmologic manifestations. This study aims to investigate the correlation between tumor volume with the presenting symptoms and postoperative outcomes. METHODS This retrospective study analyzed patients who underwent surgical resection of spheno-orbital meningiomas. Tumor volumes in different compartments were measured using preoperative and postoperative imaging. Linear and logistic regression analyses were used to identify correlations between tumor volumes and presenting symptoms preoperatively and postoperative outcomes. RESULTS Sixty-six patients were included in this study, of whom 86.4% had proptosis, 80.3% had decreased visual acuity (VA), 30.3% had visual field defects, and 13.6% had periorbital edema. Preoperatively, proptosis linearly correlated with intraosseous tumor volume (coefficient = 0.6, P < .001), while the decrease in baseline VA correlated with the intraorbital tumor volume (coefficient = 0.3, P = .01). The odds of periorbital edema were found to increase with an increase in intraosseous tumor volume with an adjusted odds ratio of 1.4 (95% CI, 1.1-1.7, P = .003), while the odds of visual field defects were found to increase with an increase in intraorbital tumor volume with an adjusted odds ratio of 2.7 (95% CI, 1.3-5.6, P = .01). Postoperatively, the volume of intraosseous tumor resected linearly correlated with the improvement in proptosis (coefficient = 0.7, P < .001), while the volume of intraorbital tumor resected linearly correlated with improvement in VA (coefficient = 0.5, P < .001) and with a larger effect size in patients presenting with moderate-to-severe decrease in VA preoperatively (coefficient = 0.8). CONCLUSION Underscoring the importance of each tumor compartment relative to the patient's symptomatology serves as a valuable guide in implementing a compartmentalized resection approach tailored to the surgical objectives.
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Affiliation(s)
- Youssef M Zohdy
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Fadi Jacob
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Matthew Agam
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Ali Alawieh
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - David Bray
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | | | - Samson A Argaw
- Rollins School of Public Health, Emory University, Atlanta , Georgia , USA
| | - Justin Maldonado
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Alejandra Rodas
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Vivek Sudhakar
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Edoardo Porto
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan , Italy
| | - Jason H Peragallo
- Department of Ophthalmology, Emory University School of Medicine, Atlanta , Georgia , USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta , Georgia , USA
| | - Jeffrey J Olson
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Gustavo Pradilla
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Tomas Garzon-Muvdi
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
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Zohdy YM, Jahangiri A, Alawieh A, Agam M, Cosgrove M, Jacob F, Porto E, Argaw SA, Rodas A, Maldonado J, Chandler KE, Barbero JMR, De Andrade E, Patel B, Tariciotti L, Vergara S, Pradilla G, Garzon-Muvdi T. Superior orbital fissure narrowing and tumor-associated pain in spheno-orbital meningiomas. Acta Neurochir (Wien) 2024; 166:113. [PMID: 38416213 DOI: 10.1007/s00701-024-05979-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/14/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Spheno-orbital meningiomas (SOMs) represent a distinct subtype of meningioma characterized by their unique multi-compartmental invasion pattern. Previous studies have investigated correlations between SOMs and visual manifestations. However, our comprehension of pain associated with SOMs remains limited. This study aims to provide insight into the pathophysiology underlying SOM-related pain through measurements of tumor volume and superior orbital fissure (SOF) narrowing. METHODS This retrospective study included patients who underwent surgical resection of a SOM between 2000 and 2022. Preoperative CT and/or MRI scans were analyzed, and the tumor volume of each segment was measured. Bony 3D reconstructions were used to measure the area of the SOF, and SOF narrowing was calculated. RESULTS The study cohort included 66 patients diagnosed with SOMs, among which 25.8% (n = 17) presented with pain. Postoperatively, 14/17 (82.4%) of patients reported pain improvement. There was no significant correlation between the total volume or the volume of tumor within each compartment and the presence of pain on presentation (p > 0.05). The median SOF narrowing was significantly different between patients presenting with and without tumor-associated pain with median of 11 mm2 (IQR 2.8-22.3) and 2 mm2 (IQR 0-6), respectively (p = 0.005). Using logistic regression, a significant correlation between the degree of SOF narrowing and the presence of SOM-associated pain on presentation was identified, with an aOR of 1.2 (95% CI 1.12-1.3, p = 0.02). CONCLUSION While the exact cause of tumor-associated pain remains unclear, SOF narrowing seems to play a role in pain among SOM patients. Based on the radiological characteristics, SOF neurovascular decompression is recommended in SOM patients.
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Affiliation(s)
- Youssef M Zohdy
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Arman Jahangiri
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Ali Alawieh
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Matthew Agam
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Megan Cosgrove
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Fadi Jacob
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Edoardo Porto
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Samson A Argaw
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alejandra Rodas
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Justin Maldonado
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Katherine E Chandler
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | | | - Erion De Andrade
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Biren Patel
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Leonardo Tariciotti
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Silivia Vergara
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Gustavo Pradilla
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Tomas Garzon-Muvdi
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA.
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Zohdy YM, Solares CA, Pradilla G, Garzon-Muvdi T. A Compartmentalized Classification for Sphenoorbital Meningiomas. World Neurosurg 2023:S1878-8750(23)01650-9. [PMID: 37992990 DOI: 10.1016/j.wneu.2023.11.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Affiliation(s)
- Youssef M Zohdy
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - C Arturo Solares
- Department of Otolaryngology, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Gustavo Pradilla
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Tomas Garzon-Muvdi
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
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Palamenghi A, Cellina M, Cè M, Cappella A, Sforza C, Gibelli D. Correlation Analysis on Anatomical Variants of Accessory Foramina in the Sphenoid Bone for Oncological Surgery. Cancers (Basel) 2023; 15:5341. [PMID: 38001601 PMCID: PMC10670589 DOI: 10.3390/cancers15225341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
The sphenoid bone presents several anatomical variations, including accessory foramina, such as the foramen meningo-orbitale, the foramen of Vesalius, the canaliculus innominatus and the palatovaginal canal, which may be involved in tumor invasion or surgery of surrounding structures. Therefore, clinicians and surgeons have to consider these variants when planning surgical interventions of the cranial base. The prevalence of each variant is reported in the published literature, but very little information is available on the possible correlation among different variants. Here, 300 CT scans of patients (equally divided among males and females) were retrospectively assessed to investigate the presence of the foramen meningo-orbitale, the foramen of Vesalius, the canaliculus innominatus and the palatovaginal canal. Possible differences in the prevalence of each accessory foramen according to sex were assessed, as well as possible correlations among different variants through the Chi-square test (p < 0.01). Overall, the prevalence of the foramen meningo-orbitale, the foramen of Vesalius, the canaliculus innominatus and the palatovaginal canal was 30.7%, 67.7%, 14.0% and 35.3%, respectively, without any difference according to sex (p > 0.01). A significant positive correlation was found between the foramen of Vesalius and canaliculus innominatus, both in males and in females (p < 0.01). In detail, subjects with canaliculus innominatus in 85.7-100.0% of cases also showed the foramen of Vesalius, independently from sex and side. The present study provided novel data about the prevalence of four accessory foramina of the sphenoid bone in an Italian population, and a correlation between the foramen of Vesalius and the canaliculus innominatus was found for the first time. As these accessory foramina host neurovascular structures, the results of this study are thus useful for appropriate planning surgical procedures that are tailored to the anatomical configuration of the patient and for improving techniques to avoid accidental injuries in cranial base surgery. Knowledge of the topography, frequencies and the presence/absence of these additional foramina are pivotal for a successful procedure. Clinicians and surgeons may benefit from these novel data for appropriate recognition of the variants, decision-making, pre-operative and treatment planning, improvement of the procedures, screening of patients and prevention of misdiagnosis.
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Affiliation(s)
- Andrea Palamenghi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via L. Mangiagalli, 31, 20133 Milan, Italy
| | - Michaela Cellina
- Reparto di Radiologia, Ospedale Fatebenefratelli, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde, 3, 20121 Milan, Italy
| | - Maurizio Cè
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Annalisa Cappella
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via L. Mangiagalli, 31, 20133 Milan, Italy
- U.O. Laboratorio di Morfologia Umana Applicata, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Chiarella Sforza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via L. Mangiagalli, 31, 20133 Milan, Italy
| | - Daniele Gibelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via L. Mangiagalli, 31, 20133 Milan, Italy
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Korn P, Spalthoff S, Gellrich NC, Lentge F, Hermann E, Krauss JK, Jehn P. Patient-specific implants for reconstruction of orbit and skull following resection of spheno-orbital meningiomas: A two-implant concept. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101408. [PMID: 36736731 DOI: 10.1016/j.jormas.2023.101408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The surgical treatment of spheno-orbital meningioma (SOM) is challenging. In addition to anatomical constraints that lead to a difficult resection, the reconstruction of the resulting defect is demanding. Uniform recommendations concerning the best reconstruction technique are not available in the existing literature. We propose a novel two-piece concept for reconstructing post-ablative defects using patient-specific implants. MATERIAL AND METHODS Between 2018 and 2021, seven patients underwent SOM resection using two digitally planned patient-specific implants for orbit and skull reconstruction. To analyze the accuracy of the reconstruction, preoperative plans were merged with postoperative data sets. The clinical outcome was evaluated by comparing the pre- and postoperative exophthalmos index (EI). RESULTS In all cases, adequate reconstruction and a satisfactory match between the final implant position and preoperative planning were achieved. The EI was reduced in all cases from a mean of 1.27 to 1.09 (p = 0.003). CONCLUSIONS The proposed concept of a two-piece reconstruction after SOM resection is an excellent way to manage the concern around post-ablative defects. The current technical conditions allow for a precise, safe, and predictable reconstruction.
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Affiliation(s)
- Philippe Korn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
| | - Simon Spalthoff
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Fritjof Lentge
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Elvis Hermann
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Philipp Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
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Gousias K, Trakolis L, Simon M. Meningiomas with CNS invasion. Front Neurosci 2023; 17:1189606. [PMID: 37456997 PMCID: PMC10339387 DOI: 10.3389/fnins.2023.1189606] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
CNS invasion has been included as an independent criterion for the diagnosis of a high-grade (WHO and CNS grade 2 and 3) meningioma in the 2016 and more recently in the 2021 WHO classification. However, the prognostic role of brain invasion has recently been questioned. Also, surgical treatment for brain invasive meningiomas may pose specific challenges. We conducted a systematic review of the 2016-2022 literature on brain invasive meningiomas in Pubmed, Scopus, Web of Science and the Cochrane Library. The prognostic relevance of brain invasion as a stand-alone criterion is still unclear. Additional and larger studies using robust definitions of histological brain invasion and addressing the issue of sampling errors are clearly warranted. Although the necessity of molecular profiling in meningioma grading, prognostication and decision making in the future is obvious, specific markers for brain invasion are lacking for the time being. Advanced neuroimaging may predict CNS invasion preoperatively. The extent of resection (e.g., the Simpson grading) is an important predictor of tumor recurrence especially in higher grade meningiomas, but also - although likely to a lesser degree - in benign tumors, and therefore also in brain invasive meningiomas with and without other histological features of atypia or malignancy. Hence, surgery for brain invasive meningiomas should follow the principles of maximal but safe resections. There are some data to suggest that safety and functional outcomes in such cases may benefit from the armamentarium of surgical adjuncts commonly used for surgery of eloquent gliomas such as intraoperative monitoring, awake craniotomy, DTI tractography and further advanced intraoperative brain tumor visualization.
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Affiliation(s)
- Konstantinos Gousias
- Department of Neurosurgery, St. Marien Academic Hospital Lünen, KLW St. Paulus Corporation, Luenen, Germany
- Medical School, Westfaelische Wilhelms University of Muenster, Muenster, Germany
- Medical School, University of Nicosia, Nicosia, Cyprus
| | - Leonidas Trakolis
- Department of Neurosurgery, St. Marien Academic Hospital Lünen, KLW St. Paulus Corporation, Luenen, Germany
| | - Matthias Simon
- Department of Neurosurgery, Bethel Clinic, Medical School, Bielefeld University, Bielefeld, Germany
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Mariniello G, Bonavolontà G, Tranfa F, Iuliano A, Corvino S, Teodonno G, Maiuri F. Management of the skull base invasion in spheno-orbital meningiomas. Br J Neurosurg 2023:1-8. [PMID: 36593639 DOI: 10.1080/02688697.2022.2161472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/06/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The tumor invasion of the skull base structures is very frequent in spheno-orbital meningiomas. The aim of the present study is to evaluate the invasion rate of skull base structures and the best surgical approach and management. METHODS The surgical series of 80 spheno-orbital meningiomas was reviewed. The tumors were classified according to the intraorbital location with respect to the optic nerve axes into three types: I-lateral: II-medial; III-diffuse. The invasion of the orbital apex, optic canal, superior orbital fissure, anterior clinoid, ethmoid-sphenoid sinuses, and infratemporal fossa was evaluated. The rate and extension of involvement of these structures was correlated with the intraorbital location and the surgical approach. The preoperative ophtalmological symptoms and signs and their outcome were also evaluated. RESULTS Proptosis was found in 79 patients (97%), variable decrease of the visual function in 47 patients (59%), and deficits of the eye movements in 28(35%). The invasion of the optic canal (74%), superior orbital fissure (65%), anterior clinoid (60%), and orbital apex (59%) was more frequently found, whereas the tumor extension into the ethmoid-sphenoid sinuses (4%) and infratemporal fossa (4%) was rare. Types II and III meningiomas showed significantly higher involvement of the skull base structures than type I ones, which only had 15% invasion of the optic canal. Remission or significant improvement of the visual function occurred postoperatively in 24 among 47 cases (51%), with a higher rate for type I meningiomas vs. other types (p = 0.021, p = 0.019) and worsening in 7 (15%). CONCLUSIONS Spheno-orbital meningiomas growing in the lateral orbital compartment show no involvement of the skull base structures excepting the optic canal as compared to those growing medially or diffusely. The surgical resection of tumor invading the skull base structures should be more extensive as possible, but the risk of optic and oculomotor deficits must be avoided.
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Affiliation(s)
- Giuseppe Mariniello
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
| | - Giulio Bonavolontà
- Ophthalmological Clinic, School of Medicine, "Federico II" University of Naples, Naples, Italy
| | - Fausto Tranfa
- Ophthalmological Clinic, School of Medicine, "Federico II" University of Naples, Naples, Italy
| | - Adriana Iuliano
- Ophthalmological Clinic, School of Medicine, "Federico II" University of Naples, Naples, Italy
| | - Sergio Corvino
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
| | - Giuseppe Teodonno
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
| | - Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
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Virtual Surgical Planning for Intracranial Intraosseous Meningioma Reconstruction. J Craniofac Surg 2021; 32:2536-2538. [PMID: 34224462 DOI: 10.1097/scs.0000000000007934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To assess the use of custom-made intracranial implants and three-dimensional cutting guides to direct the intracranial, intraorbital, and temporal reconstruction process for intraosseous meningioma. METHODS A retrospective analysis was conducted on 6 patients who were operated on by the senior author for intraosseous meningioma between 2017 and 2020. Three-dimensional models of the maxillofacial skeleton were created from preoperative virtual planned reconstruction and postoperative computed tomography scan images in the Mimics and 3-Matics software. Orbital reconstruction and temporal implant accuracy assessments were performed through the Materialise Mimics software. RESULTS Orbital cone volume had a mean discrepancy between the planned and actual orbital volume of 1.5% ± 1.6%. The reconstructed postoperative orbital volume was within 1.3% ± 2.0% of the unaffected orbit. Temporal bone reconstructions had a mean implant accuracy of 81.0%. CONCLUSIONS Our results show that the postextirpative intracranial applications of virtual surgical planning are particularly suited for high fidelity reconstructions such as orbital reconstructions, as well as temporal reconstructions with intraoperative adjustments. Custom implants and virtual three-dimensional planning is particularly ideal and promising for intraosseous meningiomas given the involvement of complex intracranial and intraorbital bony structures.
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Agi J, Badilla J, Steinke D, Mitha AP, Weis E. The Alberta standardized orbital technique in the management of spheno-orbital meningiomas. Eur J Ophthalmol 2020; 31:2686-2691. [PMID: 33008278 DOI: 10.1177/1120672120960332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a standardized orbital resection technique and outcomes for spheno-orbital meningiomas with soft-tissue invasion of the orbit. METHODS A retrospective case review of patients with spheno-orbital meningioma that underwent resection utilizing the Alberta Standardized Orbital Technique (ASOT) between 2008 and 2017 was performed. RESULTS Twenty patients met the inclusion criteria. Fifteen females and five males, with an average age of 53.4 years (SD ± 13.1 years). Mean follow-up was 57.3 months (SD ± 29.5 months). Eight cases (40%) had attempted resection prior to referral. Based on pre-operative plan, patients were divided into two groups based on goal of resection. Of those with planned complete resection (Group I), 11/13 patients (84.6%) underwent complete excision, with no cases of orbital recurrence. Incomplete resection in two cases occurred because of unexpected involvement of critical intra-cranial structures. Thus, in total 9/20 patients (Group II and 2 from Group I) underwent subtotal resection. Of these incomplete resections, five cases of orbital recurrence were observed; four patients required adjuvant external beam radiotherapy (EBRT) and one patient underwent further debulking surgery. Orbital control was achieved in three of these recurrent cases. Complications reported were persistent postoperative diplopia (three cases/15%) and wound infection (one case/5%). Overall, stable orbital disease was obtained in 18 patients (90%). CONCLUSION The ASOT demonstrated to be effective, achieving the pre-operative plan of complete resection in 11/13 cases (84.6%) with no recurrence in those with clear orbital margins.
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Affiliation(s)
- Jorge Agi
- Department of Ophthalmology, University of Calgary, Calgary, AB, Canada
| | - Jaime Badilla
- Department of Ophthalmology, University of Alberta, Edmonton, AB, Canada
| | - David Steinke
- Department of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Alim P Mitha
- Department of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | - Ezekiel Weis
- Department of Ophthalmology, University of Calgary, Calgary, AB, Canada.,Department of Ophthalmology, University of Alberta, Edmonton, AB, Canada
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Female gender and exogenous progesterone exposition as risk factors for spheno-orbital meningiomas. J Neurooncol 2020; 149:95-101. [PMID: 32705456 DOI: 10.1007/s11060-020-03576-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The great heterogeneity of meningiomas is challenging and we need to distinguish relevant subgroups. Spheno-orbital osteomeningiomas (SOOM) constitute a clinically specific entity, with slow-growing benign osteo-meningiomatous tumors, which recur after surgery in one fourth of cases. Neurosurgical daily practice, supported by the literature, shows that the vast majority of patients with SOOM are women, and we explored whether their epidemiological and hormonal profiles suggest a progesterone influence. METHODS We retrospectively documented all radiologically and histologically confirmed cases of SOOM operated in 2005-2019 in our institution. We completed the clinical and hormone history by systematic telephone interviews. RESULTS In the literature, SOOM occur significantly more often in women than other meningiomas (749/847, 86.4% versus 73.8%, p = 0.002). Among 175 cases, we included 124 patients, 93.5% were women, younger than men (51 ± 5 versus 63 ± 8, p = 0.02). Women' meningiomas showed more progesterone receptors (96.4% versus 50%, p < 0.001). Exogenous hormonal intake, reliable in 82 cases, concerned 83.3% (64/78) of women, with frequent progesterone intake: 13 oestroprogestogenic treatment only, with old-generation progesterone analogs, 41 progesterone analogs (cyproterone acetate, nomegestrol acetate, chlormadinone, promegestone, etonogestrel, levonogestrel), 7 substitutive hormonal therapy for menopause, 3 others. Duration of treatment was 2-40 years, median 10 years. CONCLUSIONS SOOM develop preferentially in women in their fifties, who often received progesterone analogs, and show progesterone receptors. Progesterone analogs are incriminated in skull base meningiomas, and this is the first report on the prevalence of exogenous hormone therapy specifically in SOOM. Whether SOOM reduce after treatment discontinuation, in particular the osteoma part, needs to be explored. Anti-progesterone treatments may represent an avenue for future research in soom.
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Menon S, O S, Anand D, Menon G. Spheno-Orbital Meningiomas: Optimizing Visual Outcome. J Neurosci Rural Pract 2020; 11:385-394. [PMID: 32753802 PMCID: PMC7394617 DOI: 10.1055/s-0040-1709270] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Spheno-orbital meningiomas (SOMs) constitute a rare cause for orbital proptosis and visual impairment. This study aims to share our outcome experience with regard to vision and exophthalmos following the surgical management of 17 patients with SOM. Methods Retrospective analysis of the case records of all surgically treated SOMs in the last 10 years. Exophthalmos index (EI) was calculated based on preoperative magnetic resonance imaging/computed tomography imaging. Vision was assessed using the Snellen's chart and Goldman's perimeter. Orbital volume was calculated using three-dimensional volume rendering assisted region-of-interest computation. Preoperative duration of symptoms and extent of surgery were the other predictors analyzed. Results Patients' age ranged from 17 to 72 years (mean, 50.57 y; median, 50.0 years). Women represented 13 (76.4%) of the entire study group. Proptosis (14/17; 82.4%) and visual impairment (14/17; 82.3%) were the two most common presenting complaints followed by headache (12/17; 70.1%). Gross total resection (GTR) was achieved in only 2 of the 17 patients (11.8%). Majority of the tumors were benign World Health Organization Grade I meningiomas (14/17; 84%). Mean follow-up time for the entire cohort was 56 months. Postoperatively, proptosis improved in nine (64.3%) and remained static in the rest five (35.7%) of patients. Four patients (28.6%) improved in vision following surgery. Vision remained static in eight patients (57.1%). Vision deteriorated in two (14.3%) patients who had severe preoperative visual deficits. New onset oculomotor palsy, trigeminal dysfunction, and mechanical ocular motility restriction were noticed in three (17.6%), two (11.2%), and six (35.3%) patients, respectively. The mean preoperative orbital volume was 21.68 ± 3.2 cm 3 and the mean postoperative orbital volume was 23.72 ± 3.4 cm 3 . Orbital volume was inversely related to EI. Optic canal (OC) deroofing and extensive orbital wall decompression facilitated visual improvement and proptosis reduction. None of the variables including orbital volume proved to be statistically significant in predicting outcome. Conclusion SOMs constitute a rare subgroup of skull base meningiomas that pose considerable surgical challenges. A surgical strategy aimed at safe maximal resection rather than aggressive GTR provides favorable outcome with less morbidity. Adequate bony decompression of the orbital walls and OC provides satisfactory improvements in proptosis and vision. Residual disease is common, but the risk of symptomatic recurrence is low especially when combined with adjuvant radiotherapy. Visual outcome is likely to be poor in patients presenting with severely compromised vision.
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Affiliation(s)
- Sudha Menon
- Department of Ophthalmology, Kasturba Medical College, Manipal, India
| | - Sandesh O
- Department of Neurosurgery, Kasturba Medical College, Manipal, India
| | - Debish Anand
- Department of Neurosurgery, Kasturba Medical College, Manipal, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, India
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