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Mariniello G, Center for Neuroscience at the Federico II University of Naples, Italy, analyzed risk factors for SOM recurrence and discussed ways to deal with SOM recurrence, and the results were published online
in the May 2022 issue of World Neurosurgery.
—Excerpted from the article chapter
【Ref: Mariniello G, et al.
World Neurosurg.
2022 May; 161:e514-e522.
doi: 10.
1016/j.
wneu.
2022.
02.
048.
Epub 2022 Feb 26】
Research background
Spheno-orbital meningiomas (SOM) often spread along surrounding structures, invading the sphenoid, orbit and dura, and even growing into the orbital apex, optic tube, and supraorbital fissure
.
To cure, it is necessary to remove the entire tumor and the invaded durum and bone, and open the sinuses if necessary, which is difficult
to operate.
With a high recurrence rate
of maximal safe resection while preserving function.
Mariniello G, Center for Neuroscience at the Federico II University of Naples, Italy, analyzed risk factors for SOM recurrence and discussed ways to deal with SOM recurrence, and the results were published online
in the May 2022 issue of World Neurosurgery.
Research methods
with loss to follow-up.
The researchers divided 80 patients into two groups; Among them, 30 cases of postoperative recurrence were in the relapse group, and 50 cases of non-recurrence after surgery were in the non-recurrence group, with an average follow-up of 136 months (5-336 months).
87% of women in the relapse group, with an average age of 48 years; Women in the non-relapse group accounted for 80% of the population, with a mean age of 45 years
.
In the relapsed group, except for one patient who had no exophthalmos, the rest had different degrees of exophthalmos
.
63% of the relapsed group had visual field defects and 40% of eye movement disorders; 56% of the non-recurrence group had visual field defects and 32% of eye movement disorders; There was no statistically significant difference
between the two groups.
By tumor location and extension range, there were 4 types: type I (lateral and superior lateral) 20 cases, type II (medial and inferior medial) 13 cases, type III (orbital apex) 30 cases, type IV (diffusion extended to the orbit) 17 cases
.
There was a statistically different recurrence rate between type I + II and type III + IV (P=0.
004).
Both type III and IV tumors invade the optic neural tube, type II 69% invade, type I only 15% invade.
Forty-eight cases extended to the anterior bed process, 52 cases extended to the supraorbital fissure, 47 cases extended to the orbital apex, 3 cases extended to the ethmoid sinus and sphenoid sinus, and 3 cases extended to the infratemporal fossa
.
There was a statistically significant difference in the proportion of epiorbital fissures, infratemporal fossa, ethmoid sinuses and sphenoid sinuses between the relapsed group and the non-relapsed group (P=0.
0049), while there was no statistical difference
in the rest.
All patients with type I underwent lateral orbital approach, 11 patients with type II.
, all type III.
and 13 patients with type IV underwent superior orbital pterygoid approach, 2 patients with type II underwent superior orbital pterygoid approach + medial orbital open approach, 3 patients with type IV.
underwent frontal temporal orbital zygomatic approach, and 1 patient with type IV.
underwent medial orbitotomy
.
All patients with type I, 77% of type II, 63% of type III, and 18% of type IV patients had complete resection (Simpson grade 1 and 2).
Patients with grades 1 and 2 of first surgical resection had significantly lower recurrence rates than patients with grades 3 and 4 of Simpson (P=0.
0032 and P=0.
0002).
Patients with grades 1 and 2 of resection had significantly longer progression-free survival at 5 years than patients with grades 3 and 4 of Simpson (P=0.
0004 and P=0.
0001).
Research results
Of the patients, 52 were WHO Class I and 28 were WHO Class
II.
There were 19 cases of WHO class II in the relapsed group and 9 cases of WHO class II in the non-relapse group (P=0.
0001).
Of all patients, 40 had improved visual acuity after surgery, 7 had deterioration, and 5 had deterioration
in oculomotor function.
In the relapse group, 21 cases had exacerbation of exophthalmos, 4 cases of deterioration of visual acuity, and 5 cases of simultaneous exophthalmos and visual acuity deterioration
.
In the relapsing group, 18 patients received complete re-operation without radiotherapy, and the remaining 4 cases of postoperative total resection and 8 cases of postoperative subtotal resection were reoperated or radiotherapy
.
Of the 9 cases of third surgery, 2 cases did not recur after total resection, and the remaining 7 cases had re-progression of tumors, of which 3 cases had no indication for
reoperation.
Three cases died in the non-relapse group and 10 patients in the relapsed group had second postoperative progression, of which 4 died
.
Conclusion of the study
The risk of recurrence of orbital meningiomas depends on the degree of tumor resection, whether the tumor extends to the supraorbital fissure, infratemporal fossa, sphenoid sinus and other sites before surgery, and WHO grade
.
The coping strategy for recurrent meningiomas is surgery to stop tumor progression, while radiotherapy
is the option for patients with recurrent WHO class II.
Because meningiomas progress slowly, patients whose tumors infiltrate the skull even after multiple surgeries have a longer survival and a higher quality of life
.
