经眶入路神经内镜手术治疗蝶眶脑膜瘤的疗效分析

Transorbital neuroendoscopic surgery for patients with spheno-orbital meningioma(report of 18 cases)

目的 探讨经眶入路神经内镜手术治疗蝶眶脑膜瘤的疗效。方法 回顾性分析2015年12月至2021年2月经眶入路神经内镜手术治疗的18例蝶眶脑膜瘤的临床资料。结果 经眶入路手术9例,扩大经眶入路手术9例。肿瘤全切除3例,次全切除4例,部分切除11例。未全切除的15例中,13例肿瘤累及海绵窦,8例有眶内受累,8例有鞍旁、翼腭窝、颞下窝或颞肌受累。11例术后辅助伽玛刀治疗,1例术后辅助放疗。术后出现一过性眼球外活动受限3例,感觉减退2例,脑脊液漏1例。与正常侧相比,患侧眼眶软组织体积减少(91.18±8.19)%,术后眼眶软组织体积增加(113.73±12.92)%。术后眼球突出程度[(1.5±1.9)mm]较术前[(4.2±2.3)mm]明显降低(P<0.05)。10例压迫性视神经病变视力、视野明显改善。术后未出现视力恶化。18例术后平均随访(20.4±10.4)个月,2例肿瘤进展,2例肿瘤复发。结论 经眶入路神经内镜手术是治疗蝶眶脑膜瘤的一种有效方法,对肿瘤切除是有效的,而且不会引起严重的不良反应,对压迫性视神经病变也很一定的疗效。

Objective To investigate the efficacy of transorbital neuroendoscopic surgery(TNS) for the patients with sphenoorbital meningioma(SOM). Methods The clinical data of 18 patients with SOM who underwent TNS from December 2015 to February2021 were retrospectively analyzed. Results Nine patients underwent surgery through orbital approach and 9 through extended orbital approach. Total tumor resection was achieved in 3 patients, subtotal in 4, and partial in 11. The cavernous sinuses were invaded by the tumors in 13 patients of 15 patients with incomplete resection, the orbital bone was invaded in 8 patients, and the parasellar,pterygopalatine fossa, infratemporal fossa, and temporalis muscle were invaded in 8 patients. Adjuvant gamma knife therapy was performed in 11 patients, and adjuvant radiotherapy was performed in 1 patient after operation. Transient extraocular activity limitation occurred in 3 patients, hypoesthesia in 2, and cerebrospinal fluid leakage in 1 after operation. Compared with the normal side, the orbital soft tissue volume of the affected side decreased by(91.18 ± 8.19)%, and the postoperative orbital soft tissue volume increased by(113.73±12.92)%. The degree of proptosis after surgery [(1.5±1.9) mm] was significantly lower than that [(4.2±2.3) mm] before surgery(P<0.05). The visual acuity and visual field of 10 patients with compressive optic neuropathy were significantly improved. No visual deterioration occurred after operation. The follow-up of 18 patients(average, 20.4±10.4 months) showed tumor progression in 2 patients and tumor recurrence in 2 patients. Conclusions TNS is an effective method for the treatment of patients with SOM, which is effective for tumor resection without serious adverse reactions, and has a certain curative effect on compressive optic neuropathy.