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Lasunin N, Cherekaev V, Abdullaev A, Gadzhiagaev V, Danilov G, Strunina Y, Golbin D, Okishev D. Reconstruction of orbital walls after resection of cranioorbital meningiomas: a systematic review and meta-analysis of individual patient data. Neurosurg Rev 2023; 46:268. [PMID: 37831295 DOI: 10.1007/s10143-023-02178-y] [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: 07/02/2023] [Revised: 09/08/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023]
Abstract
Following meningioma removal, there are numerous methods available for reconstructing the orbital wall. This systematic review seeks to summarize the published data on the surgical treatment of cranioorbital meningiomas, and to analyze the effectiveness and safety of various techniques and materials used for the reconstruction of bony orbital walls. We conducted a search of the two databases and included original articles with a series of 10 or more cases. Descriptive statistics and meta-analysis of individual patient date were performed. The analysis included a total of 858 patients from 29 sources. No reconstruction of the orbital walls was performed in 525 patients (61.2%), while 333 observations (38.8%) involved resection followed by reconstruction. A relative improvement in eye position was achieved in 94.4% of cases with a 95% CI of (88.92%; 97.25%). However, normalization of eye position, regardless of reconstruction technique, was only present in 6.22% of cases with a 95% CI of (1.24%; 25.9%). The best results were observed with the use of autologous bone implants (64%, 95% CI [33.35%; 86.33%]) and titanium implants (55.78%, 95% CI [2.86%; 98.18%]). In cases of endoscopic resection and microsurgical resection without reconstruction, symmetrical eye position accounted for only 1.94% (95% CI [0%; 96.71%]) and 2.35% (95% CI [0.13%; 31.23%]), respectively. The frequency of normalization of eye position differed significantly (p < 0.01) among the subgroups. A total of 49 postoperative complications were registered, with wound infection (1.52%, 95% CI [0.86%; 2.65%]) and wound cerebrospinal fluid leak (1.32%, 95% CI [0.6%; 2.91%]) being the most frequent. No significant differences were found in the rates of complications among the different subgroups. One of the primary objectives of cranioorbital meningioma surgery is to correct the position of the eye. Simultaneous reconstruction of the bony orbital leads to better cosmetic outcomes. Postoperative complications did not depend on the reconstructive technique or the materials.
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Affiliation(s)
- Nikolay Lasunin
- Burdenko National Medical Research Center for Neurosurgery, Moscow, Russian Federation
| | - Vasiliy Cherekaev
- Burdenko National Medical Research Center for Neurosurgery, Moscow, Russian Federation
| | - Abdulla Abdullaev
- Burdenko National Medical Research Center for Neurosurgery, Moscow, Russian Federation
| | - Vadim Gadzhiagaev
- Burdenko National Medical Research Center for Neurosurgery, Moscow, Russian Federation.
| | - Gleb Danilov
- Burdenko National Medical Research Center for Neurosurgery, Moscow, Russian Federation
| | - Yulia Strunina
- Burdenko National Medical Research Center for Neurosurgery, Moscow, Russian Federation
| | - Denis Golbin
- Burdenko National Medical Research Center for Neurosurgery, Moscow, Russian Federation
| | - Dmitriy Okishev
- Burdenko National Medical Research Center for Neurosurgery, Moscow, Russian Federation
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Trakolis L, Petridis AK. Interdisciplinary Therapeutic Approaches to Atypical and Malignant Meningiomas. Cancers (Basel) 2023; 15:4251. [PMID: 37686527 PMCID: PMC10486693 DOI: 10.3390/cancers15174251] [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: 06/20/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Meningiomas have the highest incidence among brain tumors. In contrast to benign tumors that constitute the majority of this tumor entity, the treatment of aggressive meningiomas (WHO Grade 2 and 3) is more challenging, requiring gross total removal of the tumor and the affected dura and adjuvant radiotherapy. Sometimes the location and/or the configuration of the tumor do not favor radical surgical resection without endangering the patient's clinical condition after surgery and pharmacological therapy has, until now, not been proven to be a reliable alternative. Discussion: In this narrative review, we discuss the current literature with respect to the management of meningiomas, discussing the importance of the grade of resection in the overall prognosis of the patient and in the planning of adjuvant therapy. Conclusions: According to the location and size of the tumor, radical resection should be taken into consideration. In patients with aggressive meningiomas, adjuvant radiotherapy should be performed after surgery. In cases of skull base meningiomas, a maximal, though safe, resection should take place before adjuvant therapy. An interdisciplinary approach is beneficial for patients with primary or recurrent meningioma.
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Affiliation(s)
- Leonidas Trakolis
- Department of Neurosurgery, Agios Loukas Clinic Thessaloniki, 55236 Thessaloniki, Greece;
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Di Somma A, De Rosa A, Ferrés A, Mosteiro A, Guizzardi G, Fassi JM, Topczewski TE, Reyes L, Roldán P, Torné R, Alobid I, Enseñat J. Endoscopic Transorbital Approach for the Management of Spheno-Orbital Meningiomas: Literature Review and Preliminary Experience. World Neurosurg 2023; 176:43-59. [PMID: 37024084 DOI: 10.1016/j.wneu.2023.03.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE The endoscopic transorbital approach (ETOA) is a minimally invasive approach that could be particularly appropriate for management of spheno-orbital meningiomas. The aim of this study was to perform a systematic review of the literature on the management of spheno-orbital meningiomas via the minimally invasive ETOA, searching for clinical scenarios in which this approach could be best indicated. A secondary aim was to describe 4 illustrative cases. METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data including patient demographics, tumor features, and surgical and postoperative outcomes were collected. Cases from our initial experience with ETOA were included in the data. RESULTS Data of 58 patients from 9 selected records and from our surgical series were collected. Subtotal, near-total, and gross total resection rates were 44.8%, 10.3%, and 32.7%, respectively. Symptom improvement after surgery was 100% for proptosis, 93% for visual impairment, and 87% for ophthalmoplegia. The most common postoperative complications were transient ophthalmoplegia and maxillary nerve hypoesthesia. Cerebrospinal fluid leak was reported in 2 patients. CONCLUSIONS Our findings support the use of the ETOA for management of spheno-orbital meningiomas, particularly in at least 3 clinical scenarios: 1) when predominant hyperostotic bone is present; 2) when a globular tumor not showing excessive medial or inferior infiltration is being treated; 3) as part of a multistage treatment for diffuse lesions.
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Affiliation(s)
- Alberto Di Somma
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Andrea De Rosa
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - Abel Ferrés
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Alejandra Mosteiro
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Giulia Guizzardi
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Jessica Matas Fassi
- Department of Ophthalmology, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Thomaz E Topczewski
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Luis Reyes
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Pedro Roldán
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Ramon Torné
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Isam Alobid
- Skull Base Unit, ENT Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Universidad de Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
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Holdaway M, Starner J, Patel RR, Salama J, Langer DJ, Ellis JA, Boockvar JA, D'Amico RS, Wernicke AG. Improvement in visual outcomes of patients with base of skull meningioma as a result of evolution in the treatment techniques in the last three decades: a systematic review. J Neurooncol 2023; 163:485-503. [PMID: 37354356 DOI: 10.1007/s11060-023-04366-8] [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: 05/11/2023] [Accepted: 06/07/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE We systematically reviewed visual outcomes over the last three decades in patients undergoing treatment for base of skull (BOS) meningiomas and provide recommendations to preserve vision. METHODS In accordance with the PRISMA guidelines for systematic reviews, a search was conducted from 6/1/2022-9/1/2022 using PubMed and Web of Science. Inclusion criteria included (1) patients treated for BOS meningiomas (2) treatment modality specified (3) specifics of surgical techniques and/or dose/fractions of radiotherapy (4) individual patient outcomes of treatment. Each study was assessed for bias based on study design and heterogeneity of results. RESULTS A total of 50 studies were included (N = 2911). When comparing improved vision versus unchanged or worsened vision, studies investigating surgery alone published from 2006 and onward had significantly better visual outcomes compared to pre-2006 studies (p = 0.02). When comparing improved vision versus unchanged or worsened vision, studies investigating combined therapy with surgery and radiation published from 2008 and onward had significantly better visual outcomes compared to pre-2008 studies (p < 0.01). Combined modality therapy was less likely to worsen vision compared to either surgery or radiation monotherapy (p < 0.01). However, surgery and radiation monotherapy were more likely to actually improve outcomes compared to combination therapy (p < 0.01). CONCLUSION For over a decade we have observed improvement in visual outcomes in patients managed for meningioma of BOS, likely attributing the innovation in microsurgical and more targeted and conformal radiation techniques. Combination therapy may be the safest option for preventing worsening of vision, but the highest rates of improving visual function are achieved through monotherapy when indicated.
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Affiliation(s)
| | - John Starner
- Department of Radiation Medicine, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 130 East 77th Street, New York, NY, 10065, USA
| | - Roshal R Patel
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Joshua Salama
- SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - Jason A Ellis
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - John A Boockvar
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - A Gabriella Wernicke
- Department of Radiation Medicine, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 130 East 77th Street, New York, NY, 10065, USA.
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA.
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Lasunin NV, Abdullaev AN, Cherekaev VA, Okishev DN, Grigorieva NN, Kozlov AV. [Bone defect closure after resection of sphenoorbital meningioma]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:96-103. [PMID: 36763560 DOI: 10.17116/neiro20238701196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Sphenoorbital meningiomas (SOM) are a subgroup of skull base tumors with soft tissue component in the orbit and anterior and/or middle cranial fossa. According to different authors, SOMs account for 2-12% of all intracranial meningiomas. Reconstruction of bone defects after resection of SOM has own nuances. Along with cranial vault repair, patients encounter with cosmetic defects following facial skull lesion, ophthalmic symptoms due to orbital defects, dental and functional problems associated with opening of the mouth in case of damage to maxilla and mandible. Predominant infiltrative growth of tumor and common large bone defects involving various anatomical regions require multiple implants or implants with complex shape. Moreover, contact of implantation area with nasal cavity and paranasal sinuses requires additional impermeability of soft tissue reconstruction and inertness of materials. OBJECTIVE To summarize available modern data on bone defect closure after resection of SOM. MATERIAL AND METHODS The authors reviewed available data on bone defect closure after resection of SOM. Effectiveness of modern methods of reconstruction and safety of materials were assessed. RESULTS We analyzed 96 available references. Technical features of tumor resection, materials used for bone defect closure and modern possibilities of 3D technologies in reconstructive surgery were described. The authors proposed the algorithms for selecting the materials for bone defect closure after resection of SOM. CONCLUSION Improvement of surgical technique and development of new materials and technologies significantly improve cosmetic and functional results. A large percentage of negative ophthalmologic outcomes and high risk of complications in SOM surgery require further studies and elaboration of modern techniques.
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Affiliation(s)
- N V Lasunin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | - D N Okishev
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - A V Kozlov
- Burdenko Neurosurgical Center, Moscow, Russia
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Lasunin NV, Cherekaev VA, Abdullaev AN, Danilov GV, Strunina YV, Okishev DN. [Quantitative analysis of orbit volume and eyeball position after resection of hyperostotic sphenoid wing meningioma and simultaneous orbital wall reconstruction using individual technologies]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:33-42. [PMID: 38054225 DOI: 10.17116/neiro20238706133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To conduct a quantitative analysis of orbit volume at different stages of preparation and surgical treatment of patients with cranio-orbital meningiomas undergoing resection with simultaneous orbital wall reconstruction using 3D modeling and 3D printing technologies. MATERIAL AND METHODS A prospective cohort non-randomized study included 24 patients with cranio-orbital meningiomas. The volumes were measured by segmenting the orbital structures using the planimetric method in the Inobitec PRO software package. Three expert neurosurgeons independently performed these measurements. The implants were modeled in Blender software. We used the intraclass correlation coefficient (ICC) and global similarity index (GSI) to analyze interrater agreement and ensure reproducibility of analysis. RESULTS Interrater agreement on orbital markings was very high for both metrics (ICC and GSI). The ICC (A,3) for intact orbit volume was 0.99 (95% CI 0.981; 0.996, p=1.9962018^{-33}), 0.99 (95% CI 0.983; 0.996, p=1.903203^{-34}) for damaged orbit volume at the preoperative stage, 0.99 (95% CI 0.979; 0.995, p=3.5939828^{-32}) for damaged orbit volume at the stage of modeling of resection and reconstruction, 0.99 (95% CI 0.978; 0.995, p=1.1048941^{-30}) for damaged orbit volume in postoperative period. The ICC for measurements related to EI was 0.94-0.97 (very high). This analysis revealed a strong inverse relationship between EI and volume index at the preoperative stage (rho= -0.55, p=0.004987), as well as between dynamics of EI and volume indexes in perioperative period (rho= -0.59, p=0.003). We found significant relationship (p=0.006757) between implant displacement in the area of lateral orbital wall and differences of actual and theoretical volumes. CONCLUSION The proposed method of planimetric contouring and segmentation of orbital volumes is highly accurate and reproducible. Significant patterns allow us to develop predictive models for preliminary calculation of target volume of the damaged orbit.
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Affiliation(s)
- N V Lasunin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | - G V Danilov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - D N Okishev
- Burdenko Neurosurgical Center, Moscow, Russia
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Spheno-Orbital Meningioma and Vision Impairment-Case Report and Review of the Literature. J Clin Med 2022; 12:jcm12010074. [PMID: 36614875 PMCID: PMC9821601 DOI: 10.3390/jcm12010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/11/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
(1) Background: Spheno-orbital meningioma (SOM) is a very rare subtype of meningioma which arises from the sphenoid ridge with an orbital extension. It exhibits intraosseous tumor growth with hyperostosis and a widespread soft-tissue growth at the dura. The intra-orbital invasion results in painless proptosis and slowly progressing visual impairment. (2) Methods: We present a case of a 46-year-old woman with SOM and compressive optic nerve neuropathy related to it. Her corrected distance visual acuity (CDVA) was decreased to 20/100, she had extensive visual field (VF) scotoma, dyschromatopsia, impaired pattern-reversal visual-evoked potential (PVEP), and decreased thicknesses of the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC), measured with the swept-source optical coherence tomography (SS-OCT), and a pale optic nerve disc in her left eye. Brain CT and MRI showed a lesion at the base of the anterior cranial fossa, involving the sphenoid wing and orbit. Pterional craniotomy and a partial removal of the tumor at the base of the skull and in the left orbit with the resection of the lesional dura mater and bony defect reconstruction were performed. (3) Results: The histological examination revealed meningothelial meningioma (WHO G1). Decreased CDVA and VF defects completely recovered, and the color vision score and PVEP improved following the surgery, but RNFL and GCC remained impaired. No tumor recurrence was observed at a follow-up of 78 months. (4) Conclusions: Optic nerve dysfunction has the capacity to improve once the compression has been relieved despite the presence of the structural features of optic nerve atrophy.
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Park GO, Park HH, Yoo J, Hong CK, Oh J. Surgical Outcomes of Sphenoid Wing Meningioma with Periorbital Invasion. J Korean Neurosurg Soc 2022; 65:449-456. [PMID: 35236015 PMCID: PMC9082120 DOI: 10.3340/jkns.2021.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/17/2021] [Indexed: 11/27/2022] Open
Abstract
Objective The aim of this study was to evaluate the clinical outcome of sphenoid wing meningioma with periorbital invasion (PI) after operation.
Methods Sixty one patients with sphenoid wing meningioma were enrolled in this study. Their clinical conditions were monitored after the operation and followed up more than 5 years at the outpatient clinic of a single institution. Clinical and radiologic information of the patients were all recorded including the following parameters : presence of PI, presence of peri-tumor structure invasion, pathologic grade, extents of resection, presence of hyperostosis, exophthalmos index (EI), and surgical complications. We compared the above clinical parameters of the patients with sphenoid wing meningioma in the presence or absence of PI (non-PI), then linked the analyzed data with the clinical outcome of the patients.
Results Of 61 cases, there were 14 PI and 47 non-PI patients. PI group showed a significantly higher score of EI (1.37±0.24 vs. 1.00±0.01, p<0.001), more frequent presence of hyperostosis (85.7% vs. 14.3%, p<0.001), and lower rate of gross total resection (GTR) (35.7% vs. 68.1%, p=0.032). The lower score of pre-operative EI, the absence of both PI and hyperostosis, smaller tumor size, and the performance of GTR were associated with lower recurrence rates in the univariate analysis. However, in the multivariate analysis, the performance of GTR was the only significant factor to determine the recurrence rate (p=0.043). The incidences of surgical complications were not statistically different between the subtotal resection (STR) and GTR groups, but it was strongly associated tumor size (p=0.017).
Conclusion The GTR group showed lower recurrence rate than the STR group without differences in the surgical complications. Therefore, the GTR is strongly recommended to treat sphenoid wing meningioma with PI for the better clinical outcome.
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Affiliation(s)
- Ga-On Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University, Seoul, Korea
| | - Hyun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University, Seoul, Korea
| | - Jihwan Yoo
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University, Seoul, Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jiwoong Oh
- Department of Neurosurgery, Severance Hospital, Yonsei University, Seoul, Korea
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Muhsen BA, Aljariri AI, Hashem H, Alzoubi Q, Sarhan N, Al-Hussaini M, Al Mousa A. En-plaque sphenoid wing grade II meningioma: Case report and review of literature. Ann Med Surg (Lond) 2022; 74:103322. [PMID: 35145681 PMCID: PMC8818543 DOI: 10.1016/j.amsu.2022.103322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Baha'eddin A. Muhsen
- Division of Neurosurgery, Department of Surgery, King Hussein Cancer Center, Amman, Jordan
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Corresponding author. Division of Neurosurgery, Department of Surgery, King Hussein Cancer Center, Amman, Jordan.
| | | | - Hasan Hashem
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
| | - Qasem Alzoubi
- Department of Diagnostic Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Nasim Sarhan
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
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Montemurro N, Condino S, Cattari N, D’Amato R, Ferrari V, Cutolo F. Augmented Reality-Assisted Craniotomy for Parasagittal and Convexity En Plaque Meningiomas and Custom-Made Cranio-Plasty: A Preliminary Laboratory Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18199955. [PMID: 34639256 PMCID: PMC8507881 DOI: 10.3390/ijerph18199955] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND This report discusses the utility of a wearable augmented reality platform in neurosurgery for parasagittal and convexity en plaque meningiomas with bone flap removal and custom-made cranioplasty. METHODS A real patient with en plaque cranial vault meningioma with diffuse and extensive dural involvement, extracranial extension into the calvarium, and homogeneous contrast enhancement on gadolinium-enhanced T1-weighted MRI, was selected for this case study. A patient-specific manikin was designed starting with the segmentation of the patient's preoperative MRI images to simulate a craniotomy procedure. Surgical planning was performed according to the segmented anatomy, and customized bone flaps were designed accordingly. During the surgical simulation stage, the VOSTARS head-mounted display was used to accurately display the planned craniotomy trajectory over the manikin skull. The precision of the craniotomy was assessed based on the evaluation of previously prepared custom-made bone flaps. RESULTS A bone flap with a radius 0.5 mm smaller than the radius of an ideal craniotomy fitted perfectly over the performed craniotomy, demonstrating an error of less than ±1 mm in the task execution. The results of this laboratory-based experiment suggest that the proposed augmented reality platform helps in simulating convexity en plaque meningioma resection and custom-made cranioplasty, as carefully planned in the preoperative phase. CONCLUSIONS Augmented reality head-mounted displays have the potential to be a useful adjunct in tumor surgical resection, cranial vault lesion craniotomy and also skull base surgery, but more study with large series is needed.
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Affiliation(s)
- Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy
- Correspondence:
| | - Sara Condino
- Department of Information Engineering, University of Pisa, 56100 Pisa, Italy; (S.C.); (R.D.); (V.F.); (F.C.)
- EndoCAS Center for Computer-Assisted Surgery, 56100 Pisa, Italy;
| | - Nadia Cattari
- EndoCAS Center for Computer-Assisted Surgery, 56100 Pisa, Italy;
- Department of Translational Research, University of Pisa, 56100 Pisa, Italy
| | - Renzo D’Amato
- Department of Information Engineering, University of Pisa, 56100 Pisa, Italy; (S.C.); (R.D.); (V.F.); (F.C.)
- EndoCAS Center for Computer-Assisted Surgery, 56100 Pisa, Italy;
| | - Vincenzo Ferrari
- Department of Information Engineering, University of Pisa, 56100 Pisa, Italy; (S.C.); (R.D.); (V.F.); (F.C.)
- EndoCAS Center for Computer-Assisted Surgery, 56100 Pisa, Italy;
| | - Fabrizio Cutolo
- Department of Information Engineering, University of Pisa, 56100 Pisa, Italy; (S.C.); (R.D.); (V.F.); (F.C.)
- EndoCAS Center for Computer-Assisted Surgery, 56100 Pisa, Italy;
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Masalha W, Heiland DH, Steiert C, Krüger MT, Schnell D, Scheiwe C, Schnell O, Grosu AL, Beck J, Grauvogel J. Progression-Free Survival, Prognostic Factors, and Surgical Outcome of Spheno-Orbital Meningiomas. Front Oncol 2021; 11:672228. [PMID: 34150637 PMCID: PMC8212033 DOI: 10.3389/fonc.2021.672228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Spheno-orbital meningiomas (SOM) are rare intracranial tumors that arise at the sphenoid wing. These tumors can invade important neurovascular structures making radical resection difficult, while residual tumors often lead to recurrence. The purpose of this study was to evaluate prognostic factors influencing the recurrence and progression-free survival (PFS) rates of spheno-orbital meningiomas, with a particular focus on the role of surgery and postoperative radiotherapy. Methods Between 2000 and March 2020, 65 cases of spheno-orbital meningioma were included, of which 50 cases underwent surgical treatment alone, and 15 cases underwent resection and radiotherapy. A Kaplan-Meier analysis was performed to provide median point estimates and PFS rates; further, Cox regression analysis was used to identify significant factors associated with treatment. Results Gross total resection significantly reduced the risk of recurrence (p-value = 0.0062). There was no significant benefit for progression-free survival after postoperative radiotherapy (p-value = 0.42). Additionally, spheno-orbital meningiomas with an invasion of the cavernous sinus and intraconal invasion showed significantly worse PFS compared to other locations (p-value = 0.017). Conclusion The maximal safe resection remains the most important prognostic factor associated with lower recurrence rates and longer PFS in patients with spheno-orbital meningioma. The invasion of the cavernous sinus and intraconal invasion was an independent factor associated with worse PFS. Patients with postoperative high-precision radiotherapy did not show significantly better PFS due to the small number of patients.
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Affiliation(s)
- Waseem Masalha
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dieter Henrik Heiland
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine Steiert
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marie T Krüger
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Daniel Schnell
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anca-L Grosu
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Grauvogel
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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