DOI QR코드

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Surgical Outcomes of Sphenoid Wing Meningioma with Periorbital Invasion

  • Park, Ga-On (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University) ;
  • Park, Hyun Ho (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University) ;
  • Yoo, Jihwan (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University) ;
  • Hong, Chang-Ki (Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Oh, Jiwoong (Department of Neurosurgery, Severance Hospital, Yonsei University)
  • 투고 : 2021.04.28
  • 심사 : 2021.08.17
  • 발행 : 2022.05.01

초록

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.

키워드

참고문헌

  1. Bikmaz K, Mrak R, Al-Mefty O : Management of bone-invasive, hyperostotic sphenoid wing meningiomas. J Neurosurg 107 : 905-912, 2007 https://doi.org/10.3171/JNS-07/11/0905
  2. Boari N, Gagliardi F, Spina A, Bailo M, Franzin A, Mortini P : Management of spheno-orbital en plaque meningiomas: clinical outcome in a consecutive series of 40 patients. Br J Neurosurg 27 : 84-90, 2013 https://doi.org/10.3109/02688697.2012.709557
  3. Couldwell WT, Kan P, Liu JK, Apfelbaum RI : Decompression of cavernous sinus meningioma for preservation and improvement of cranial nerve function. Technical note. J Neurosurg 105 : 148-152, 2006 https://doi.org/10.3171/jns.2006.105.1.148
  4. Elborady MA, Nazim WM : Spheno-orbital meningiomas: surgical techniques and results. Egypt J Neurol Psychiatry Neurosurg 57 : 1-9, 2021 https://doi.org/10.1186/s41983-020-00251-7
  5. Forster MT, Daneshvar K, Senft C, Seifert V, Marquardt G : Sphenoorbital meningiomas: surgical management and outcome. Neurol Res 36 : 695-700, 2014 https://doi.org/10.1179/1743132814Y.0000000329
  6. Gonen L, Nov E, Shimony N, Shofty B, Margalit N : Sphenoorbital meningioma: surgical series and design of an intraoperative management algorithm. Neurosurg Rev 41 : 291-301, 2018 https://doi.org/10.1007/s10143-017-0855-7
  7. Honig S, Trantakis C, Frerich B, Sterker I, Kortmann RD, Meixensberger J : Meningiomas involving the sphenoid wing outcome after microsurgical treatment--a clinical review of 73 cases. Cent Eur Neurosurg 71 : 189-198, 2010 https://doi.org/10.1055/s-0030-1261945
  8. Kiyofuji S, Casabella AM, Graffeo CS, Perry A, Garrity JA, Link MJ : Sphenoorbital meningioma: a unique skull base tumor. Surgical technique and results. J Neurosurg 133 : 1044-1051, 2020 https://doi.org/10.3171/2019.6.JNS191158
  9. Li Y, Shi JT, An YZ, Zhang TM, Fu JD, Zhang JL, et al. : Sphenoid wing meningioma en plaque: report of 37 cases. Chin Med J (Engl) 122 : 2423-2427, 2009
  10. Mariniello G, Maiuri F, Strianese D, Donzelli R, Iuliano A, Tranfa F, et al. : Spheno-orbital meningiomas: surgical approaches and outcome according to the intraorbital tumor extent. Zentralbl Neurochir 69 : 175-181, 2008 https://doi.org/10.1055/s-2008-1077077
  11. Masalha W, Heiland DH, Steiert C, Kruger MT, Schnell D, Scheiwe C, et al. : Progression-free survival, prognostic factors, and surgical outcome of spheno-orbital meningiomas. Front Oncol 11 : 672228, 2021 https://doi.org/10.3389/fonc.2021.672228
  12. Menon S, Sandesh O, Anand D, Menon G : Spheno-orbital meningiomas: optimizing visual outcome. J Neurosci Rural Pract 11 : 385-394, 2020 https://doi.org/10.1055/s-0040-1709270
  13. Ringel F, Cedzich C, Schramm J : Microsurgical technique and results of a series of 63 spheno-orbital meningiomas. Neurosurgery 60(4 Suppl 2) : 214-221; discussion 221-222, 2007 https://doi.org/10.1227/01.NEU.0000255415.47937.1A
  14. Saeed P, van Furth WR, Tanck M, Kooremans F, Freling N, Streekstra GI, et al. : Natural history of spheno-orbital meningiomas. Acta Neurochir (Wien) 153 : 395-402, 2011 https://doi.org/10.1007/s00701-010-0878-0
  15. Samadian M, Sharifi G, Mousavinejad SA, Amin AA, Ebrahimzadeh K, Tavassol HH, et al. : Surgical outcomes of sphenoorbital en plaque meningioma: a 10-year experience in 57 consecutive cases. World Neurosurg 144 : e576-e581, 2020 https://doi.org/10.1016/j.wneu.2020.09.002
  16. Scarone P, Leclerq D, Heran F, Robert G : Long-term results with exophthalmos in a surgical series of 30 sphenoorbital meningiomas. Clinical article. J Neurosurg 111 : 1069-1077, 2009 https://doi.org/10.3171/2009.1.JNS081263
  17. Shrivastava RK, Sen C, Costantino PD, Della Rocca R : Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management. J Neurosurg 103 : 491-497, 2005 https://doi.org/10.3171/jns.2005.103.3.0491
  18. Sughrue ME, Rutkowski MJ, Chen CJ, Shangari G, Kane AJ, Parsa AT, et al. : Modern surgical outcomes following surgery for sphenoid wing meningiomas. J Neurosurg 119 : 86-93, 2013 https://doi.org/10.3171/2012.12.JNS11539
  19. Talacchi A, Hasanbelliu A, D'Amico A, Regge Gianas N, Locatelli F, Pasqualin A, et al. : Long-term follow-up after surgical removal of meningioma of the inner third of the sphenoidal wing: outcome determinants and different strategies. Neurosurg Rev 43 : 109-117, 2020 https://doi.org/10.1007/s10143-018-1018-1
  20. Xu G, Du JX, Ye M, Zhao RL, Ling F : Analysis of the causes of surgical complications of medial sphenoidal ridge meningioma. Zhonghua Yi Xue Za Zhi 86 : 632-635, 2006