Surgery stands as the primary treatment for spheno-orbital meningiomas, following a symptoms-oriented approach. We discussed the decision-making process behind surgical strategies through a review of medical records from 80 patients who underwent surgical resection at the University of Naples Federico II. Different surgical approaches were employed based on the tumor’s location relative to the optic nerve’s long axis, categorized into lateral (type I), medial (type II), and diffuse (type III). We examined clinical, neuroradiological, surgical, pathological, and outcome factors. Proptosis emerged as the most frequent symptom (97%), followed by visual impairment (59%) and ocular motility issues (35%). Type I represented 20%, type II 43%, and type III 17%. Growth primarily affected the optic canal (74%), superior orbital fissure (65%), anterior clinoid (60%), and orbital apex (59%). The resection outcomes varied, with Simpson grades I and II achieved in all type I cases, 67.5% of type II, and 18% of type III. Recurrence rates were highest in type II (41.8%) and type III (59%). Improvement was notable in proptosis (68%) and visual function (51%, predominantly type I). Surgery for spheno-orbital meningiomas should be tailored to each patient, considering individual characteristics and tumor features to improve quality of life by addressing primary symptoms like proptosis and visual deficits.
手术是蝶眶脑膜瘤的主要治疗手段，通常采取以症状为导向的治疗策略。我们通过分析那不勒斯腓特烈二世大学80例手术切除患者的病历资料，探讨了手术方案决策过程。根据肿瘤与视神经长轴的相对位置，采用不同的手术入路，分为外侧型（Ⅰ型）、内侧型（Ⅱ型）和弥漫型（Ⅲ型）。我们系统评估了临床、神经影像、手术、病理及预后等多方面因素。眼球突出是最常见的症状（97%），其次为视力障碍（59%）和眼球运动障碍（35%）。Ⅰ型占20%，Ⅱ型43%，Ⅲ型17%。肿瘤生长主要累及视神经管（74%）、眶上裂（65%）、前床突（60%）和眶尖（59%）。切除效果存在差异：Ⅰ型病例全部达到SimpsonⅠ-Ⅱ级切除，Ⅱ型为67.5%，Ⅲ型仅18%。复发率以Ⅱ型（41.8%）和Ⅲ型（59%）最高。术后眼球突出改善率为68%，视觉功能改善率为51%（以Ⅰ型为主）。蝶眶脑膜瘤手术应根据患者个体特征和肿瘤特点进行个性化设计，通过改善眼球突出和视觉障碍等主要症状来提高患者生活质量。
Spheno-Orbital Meningiomas: The Rationale behind the Decision-Making Process of Treatment Strategy
肿瘤(癌症)患者之家