Surgical Treatment of Spheno-Orbital Meningiomas: A Systematic Review and Meta-Analysis of Surgical Techniques and Outcomes

被引:9
作者
Agosti, Edoardo [1 ]
Zeppieri, Marco [2 ]
De Maria, Lucio [1 ]
Mangili, Marcello [1 ]
Rapisarda, Alessandro [3 ]
Ius, Tamara [4 ]
Spadea, Leopoldo [5 ]
Salati, Carlo [2 ]
Tel, Alessandro [6 ]
Pontoriero, Antonio [7 ]
Pergolizzi, Stefano [7 ]
Angileri, Filippo Flavio [8 ]
Fontanella, Marco Maria [1 ]
Panciani, Pier Paolo [1 ]
机构
[1] Univ Brescia, Dept Surg Specialties Radiol Sci & Publ Hlth, Div Neurosurg, I-25123 Brescia, Italy
[2] Univ Hosp Udine, Dept Ophthalmol, Piazzale S Maria Misericordia 15, I-33100 Udine, Italy
[3] Fdn Policlin Univ Agostino Gemelli IRCSS, Dept Neurosurg, I-00168 Rome, Italy
[4] Univ Hosp Udine, Head Neck & Neurosci Dept, Neurosurg Unit, p le S Maria Misericordia 15, I-33100 Udine, Italy
[5] Sapienza Univ Rome, Policlin Umberto1, Eye Clin, I-00142 Rome, Italy
[6] Univ Hosp Udine, Head Neck & Neurosci Dept, Clin Maxillofacial Surg, p le S Maria Misericordia 15, I-33100 Udine, Italy
[7] Univ Messina, Dept Biomed Dent Sci & Morphol & Funct Images, Radiat Oncol Unit, I-98125 Messina, Italy
[8] Dept Biomed Dent Sci & Morphol & Funct Images, Neurosurg Unit, I-98125 Messina, Italy
关键词
spheno-orbital meningiomas; systematic review; meta-analysis; surgical approaches; clinical outcomes; surgical outcomes; EN-PLAQUE; WING MENINGIOMAS; SPHENOORBITAL MENINGIOMAS; STEREOTACTIC RADIOTHERAPY; MANAGEMENT; RESECTION; SERIES; THERAPY; RECONSTRUCTION; PROPTOSIS;
D O I
10.3390/jcm12185840
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Spheno-orbital meningiomas (SOMs) are rare tumors arising from the meninges surrounding the sphenoid bone and orbital structures. Surgical resection is the primary treatment approach for SOMs. Several surgical approaches have been described during the decades, including microsurgical transcranial (MTAs), endoscopic endonasal (EEAs), endoscopic transorbital (ETOAs), and combined approaches, and the choice of surgical approach remains a topic of debate. Purpose: This systematic review and meta-analysis aim to compare the clinical and surgical outcomes of different surgical approaches used for the treatment of SOMs, discussing surgical techniques, outcomes, and factors influencing surgical decision making. Methods: A comprehensive literature review of the databases PubMed, Ovid MEDLINE, and Ovid EMBASE was conducted for articles published on the role of surgery for the treatment of SOMs until 2023. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Meta-analysis was performed to estimate pooled event rates and assess heterogeneity. Fixed- and random-effects were used to assess 95% confidential intervals (CIs) of presenting symptoms, outcomes, and complications. Results: A total of 59 studies comprising 1903 patients were included in the systematic review and meta-analysis. Gross total resection (GTR) rates ranged from 23.5% for ETOAs to 59.8% for MTAs. Overall recurrence rate after surgery was 20.7%. Progression-free survival (PFS) rates at 5 and 10 years were 75.5% and 49.1%, respectively. Visual acuity and proptosis improvement rates were 57.5% and 79.3%, respectively. Postoperative cranial nerve (CN) focal deficits were observed in 20.6% of cases. The overall cerebro-spinal fluid (CSF) leak rate was 3.9%, and other complications occurred in 13.9% of cases. MTAs showed the highest GTR rates (59.8%, 95%CI = 49.5-70.2%; p = 0.001) but were associated with increased CN deficits (21.0%, 95%CI = 14.5-27.6%). ETOAs had the lowest GTR rates (23.5%, 95%CI = 0.0-52.5%; p = 0.001), while combined ETOA and EEA had the highest CSF leak rates (20.3%, 95%CI = 0.0-46.7%; p = 0.551). ETOAs were associated with better proptosis improvement (79.4%, 95%CI = 57.3-100%; p = 0.002), while anatomical class I lesions were associated with better visual acuity (71.5%, 95%CI = 63.7-79.4; p = 0.003) and proptosis (60.1%, 95%CI = 38.0-82.2; p = 0.001) recovery. No significant differences were found in PFS rates between surgical approaches. Conclusion: Surgical treatment of SOMs aims to preserve visual function and improve proptosis. Different surgical approaches offer varying rates of GTR, complications, and functional outcomes. A multidisciplinary approach involving a skull base team is crucial for optimizing patient outcomes.
引用
收藏
页数:28
相关论文
共 74 条
  • [71] Spheno-Orbital Meningioma and Vision Impairment-Case Report and Review of the Literature
    Wierzbowska, Joanna
    Zegadlo, Arkadiusz
    Patyk, Michal
    Rekas, Marek
    [J]. JOURNAL OF CLINICAL MEDICINE, 2023, 12 (01)
  • [72] Predictive factors for visual outcome after resection of spheno-orbital meningiomas: a long-term review
    Yannick, Nochez
    Patrick, Francois
    Samuel, Majzoub
    Erwan, Floch
    Pierre-Jean, Pisella
    Michel, Jan
    Stephane, Velut
    [J]. ACTA OPHTHALMOLOGICA, 2012, 90 (08) : e663 - e665
  • [73] Combined neurosurgical and orbital intervention for spheno-orbital meningiomas-the Manchester experience
    Young, J.
    Mdanat, F.
    Dharmasena, A.
    Cannon, P.
    Leatherbarrow, B.
    Hammerbeck-Ward, C.
    Rutherford, S.
    Ataullah, S.
    [J]. ORBIT-THE INTERNATIONAL JOURNAL ON ORBITAL DISORDERS-OCULOPLASTIC AND LACRIMAL SURGERY, 2020, 39 (04): : 251 - 257
  • [74] Visual outcomes endorse surgery of patients with spheno-orbital meningioma with minimal visual impairment or hyperostosis
    Zamanipoor Najafabadi, Amir H.
    Genders, Stijn W.
    van Furth, Wouter R.
    [J]. ACTA NEUROCHIRURGICA, 2021, 163 (01) : 73 - 82