Microsurgical Technique and Results of a Series of 63 Spheno-Orbital Meningiomas

Ringel, Florian; Cedzich, C.; Schramm, Johannes

doi:10.1227/01.neu.0000255415.47937.1a

Cited by 104 publications

(180 citation statements)

References 28 publications

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“…The development of complex neurosurgical approaches to the skull base and orbit as well as interdisciplinary operation teams including ophthalmic, otorhinolaryngological, and craniomaxillofacial surgeons led to a drop in morbidity rates while extent of resection increased. 12,27,28,31 However, even in these series, postoperative morbidity was reported to occur at least transiently in 30% 27 to 69% of patients. 28 Because extended skull base tumors involving bone, dura mater, and the orbital system are hard to adequately resect, recurrence rates are high.…”

Section: Discussionmentioning

confidence: 72%

Orbit-associated tumors: navigation and control of resection using intraoperative computed tomography

Terpolilli¹,

Rachinger²,

Kunz³

et al. 2016

JNS

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S kull base tumors with close anatomical association to orbit, optic nerve, and the cavernous sinus often cause neurological symptoms like loss of visual function and exophthalmus. In most cases resection (complete or partial removal) is the most promising and most effective therapeutic approach with regard to preservation or restoration of visual function. Furthermore, operative tumor removal or reduction is a crucial step in multidisciplinary operative as well as medical or radiotherapeutic treatment concepts, because it allows exact histological diagnosis and safe decompression of anatomical structures at risk. However, resection of these tumors is associated with increased perioperative morbidity due to the proximity of highly sensitive structures-e.g., cranial nerves abbreviatioNs CN = cranial nerve; iCT = intraoperative CT; iMRI = intraoperative MRI; NNS = neuronavigational system. obJective Treatment of skull base lesions is complex and usually requires a multidisciplinary approach. In meningioma, which is the most common tumor entity in this region, resection is considered to be the most important therapeutic step to avoid tumor recurrence. However, resection of skull base lesions with orbital or optic nerve involvement poses a challenge due to their anatomical structure and their proximity to eloquent areas. Therefore the main goal of surgery should be to achieve the maximum extent of resection while preserving neurological function. In the postoperative course, medical and radiotherapeutic strategies may then be successfully used to treat possible tumor residues. Methods to safely improve the extent of resection in skull base lesions therefore are desirable. The current study reports the authors' experience with the use of intraoperative CT (iCT) combined with neuronavigation with regard to feasibility and possible benefits of the method. methods Those patients with tumorous lesions in relationship to the orbit, sphenoid wing, or cavernous sinus who were surgically treated between October 2008 and December 2013 using iCT-based neuronavigation and in whom an intraoperative scan was obtained for control of resection were included. In all cases a second iCT scan was performed under sterile conditions after completion of navigation-guided microsurgical tumor resection. The surgical strategy was adapted accordingly; if necessary, resection was continued. results Twenty-three patients (19 with WHO Grade I meningioma and 4 with other lesions) were included. The most common clinical symptoms were loss of visual acuity and exophthalmus. Intraoperative control of resection by iCT was successfully obtained in all cases. Intraoperative imaging changed the surgical approach in more than half (52.2%) of these patients, either because iCT demonstrated unexpected residual tumor masses or because the second scan revealed additional tumor tissue that was not detected in the first scan due to overlay by osseous tumor parts; in these cases resection was continued. In the remaining cases resection was concluded as planned ...

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Section: Discussionmentioning

confidence: 72%

Orbit-associated tumors: navigation and control of resection using intraoperative computed tomography

Terpolilli¹,

Rachinger²,

Kunz³

et al. 2016

JNS

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“…They performed complete tumor removal in 69% of the patients and they did not perform complete resection in other patients due to cavernous sinus and pterygopalatine fossa invasions. Ringel et al (18) published their series of 63 patients with sphenoorbital meningiomas in 2007 and they concluded that the complete resection of these tumors is frequently impossible due to involvement of delicate structures in the orbital cone. Large frontotemporal craniotomy was preferred by the authors to resect the tumor-infitrated parts of the convexity dura.…”

Section: Resultsmentioning

confidence: 99%

“…But complete resection does not seem achievable without risk of complication because of the infiltrative nature of this disease and its tendency to spread over the dural surface (22). When all macroscopically visible tumor is removed totally and confirmed by postoperative MRI and CT images, this is considered as complete or total resection in many papers (5,18,19,21,22). SOF, cavernous sinus, and extraocular muscles are the main anatomical structures limiting the radical surgical resection.…”

Section: Resultsmentioning

confidence: 99%

Surgical strategies for the removal of sphenoorbital meningiomas

Solmaz¹,

Tehli²,

Temız³

et al. 2014

Turkish Neurosurgery

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AIm: Surgical removal of sphenoorbital meningiomas is challenging for neurosurgeons. The aim of study is to share our experience on sphenoorbital meningiomas and to provide a picture of the current state of the art in surgical treatment of these tumors. mATERIAl and mEThods:The data of 13 cases of sphenoorbital meningioma who were operated between 2006 and 2013 was reviewed retrospectively. Intraorbital extension was present in 10 cases while sphenoid bone invasion was detected in 9 cases. All patients underwent surgical treatment after the radiological evaluation with magnetic resonance imaging and computed tomography. The degree of resection and the clinical outcome of all patients were analyzed. REsulTs:Extended pterional approach with a large frontotemporal craniotomy was performed in all cases. Simpson's grade I and II excision was achieved in 4 (31%) cases while subtotal excision (Simpson's grade III or higher) was performed in 9 cases. The main reason for subtotal excision was the cavernous sinus invasion. Optic canal decompression was performed in patients with intraorbital invasion. CoNClusIoN:Although total removal is the main objective of surgery, the sphenoorbital meningiomas are difficult to resect especially with cavernous sinus invasion. But in the meantime, it is not recommended to take any excessive risks to achieve a greater degree of resection for a benign tumor. Endoscopic approach is an option for inferomedial orbital parts of these tumors. KEywoRds: Sphenoorbital meningioma, Surgery, Strategy ÖZAmAÇ: Sfenoorbital menenjiyomların cerrahi yolla çıkartılması nöroşirürjiyenler için oldukça zorlu bir süreçtir. Çalışmanın amacı, sfenoorbital menenjiyomlar konusunda tecrübelerimizi paylaşmak ve bu tümörlerin cerrahi tedavisi konusunda güncel yaklaşımları ortaya koymaktır. yÖNTEm ve GEREÇlER: 2006-2013 yılları arasında opere edilen 13 adet sfenoorbital menenjiyom olgusunun verileri geriye dönük olarak incelendi. On olguda intraorbital yayılım ve 9 olguda sfenoid kemik invazyonu saptandı. Tüm hastalara bilgisayarlı tomografi ve manyetik rezonans görüntülemenin ardından cerrahi tedavi uygulandı. Hastalarda tümör rezeksiyon derecesi ve klinik sonuçlar analiz edildi.BulGulAR: Tüm olgulara geniş bir frontotemporal kraniyotomi ile genişletilmiş pterional yaklaşım uygulandı. Simpson derece I ve II eksizyon 4 (%31) olguda sağlanırken, subtotal eksizyon (Simpson derece III veya daha yüksek) 9 olguda sağlandı. Subtotal eksizyonun en önemli sebebi kavernöz sinüs invazyonu idi. Optik kanal dekompresyonu intraorbital invazyon olan olgularda uygulandı. soNuÇ: Sfenoorbital menenjiyomların cerrahi tedavisinde ana hedef her ne kadar total eksizyon olsa da özellikle kavernöz sinüs invazyonu olan olgularda bu hedefe ulaşmak zordur. Aynı zamanda iyi huylu bir tümör için daha fazla rezeksiyon amacıyla yüksek risk alınmasına gerek yoktur. Bu tümörlerin inferomedial orbital kısımlarının çıkartılmasında endoskopik yaklaşım da bir seçenektir.

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“…Canal invasion often causes severe visual disturbance from compression of the nerve [5]. Spheno-orbital meningiomas may directly involve the optic canal [33]. Clinoidal meningiomas encase the optic chiasm and the nerve while respecting the arachnoid plane of the chiasmatic cistern [4].…”

Section: Onbf With Tumor Compressionmentioning

confidence: 99%

Measurement of optic nerve blood flow during dissection of parasellar tumors

et al. 2008

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The authors describe direct measurement of optic nerve blood flow and examine application of such monitoring to detect optic nerve ischemia during parasellar tumor surgery. Twenty-six patients requiring surgery for parasellar tumors were evaluated prospectively. Ophthalmologic examination was performed before and after surgery.The optic nerve blood flow was measured using a laser Doppler flowmeter before tumor dissection (initial ONBF) and after tumor removal (final ONBF). The waveform was analyzed by a data acquisition system. In 16 patients, initial ONBF could be measured (22 nerves; 8.9±0.9 ml/100 g/min). Final ONBF could be determined in all 26 patients (42 nerves; 10.8±0.7 ml/100 g/min). In the 22 nerves with initial measurements, final ONBF (11.3±0.6 ml/100 g/min) was significantly increased (p<0.01). In 6 patients whose optic canal was unroofed, the optic nerve blood flow did not change immediately; nonetheless, an increase was prominent in the final phase (p<0.05). In another 6 patients, a small vessel adjacent to the optic nerve was temporarily occluded. The optic nerve blood flow was reduced demonstrably in 3 and recovered quickly after reperfusion. Intraoperative optic nerve blood flow measurement may be useful as a real-time monitoring for prediction and prevention of intraoperative optic nerve ischemia.

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Microsurgical Technique and Results of a Series of 63 Spheno-Orbital Meningiomas

Cited by 104 publications

References 28 publications

Orbit-associated tumors: navigation and control of resection using intraoperative computed tomography

Orbit-associated tumors: navigation and control of resection using intraoperative computed tomography

Surgical strategies for the removal of sphenoorbital meningiomas

Measurement of optic nerve blood flow during dissection of parasellar tumors

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