背景:蝶眶脑膜瘤(SOM)是罕见的肿瘤,起源于蝶骨和眶结构周围的脑膜。手术切除是SOM的主要治疗方法。几十年来,已经描述了几种手术方法,包括经颅显微外科手术(MTA),鼻内镜(EEAs),内镜经眶(ETOAs),和组合方法,手术方法的选择仍然是一个争论的话题。
目的:本系统综述和荟萃分析旨在比较不同手术方式治疗SOM的临床和手术结果。讨论手术技术,结果,以及影响手术决策的因素。
方法:对PubMed,OvidMEDLINE,直到2023年,OvidEMBASE都发表了关于手术治疗SOM的作用的文章。根据系统评价的首选报告项目和荟萃分析指南进行系统评价。进行荟萃分析以估计合并事件发生率并评估异质性。固定和随机效应用于评估出现症状的95%保密间隔(CI),结果,和并发症。
结果:共有59项研究,包括1903例患者纳入系统评价和荟萃分析。总切除率(GTR)从ETOA的23.5%到MTA的59.8%不等。术后总复发率为20.7%。5年和10年的无进展生存率(PFS)分别为75.5%和49.1%,分别。视力和眼球突出改善率分别为57.5%和79.3%,分别。术后脑神经(CN)局灶性缺损占20.6%。总体脑脊液(CSF)泄漏率为3.9%,其他并发症发生在13.9%的病例中。MTA的GTR率最高(59.8%,95CI=49.5-70.2%;p=0.001),但与CN缺乏增加相关(21.0%,95CI=14.5-27.6%)。ETO的GTR率最低(23.5%,95CI=0.0-52.5%;p=0.001),而ETOA和EEA的组合具有最高的CSF泄漏率(20.3%,95CI=0.0-46.7%;p=0.551)。ETOAs与更好的突起改善相关(79.4%,95CI=57.3-100%;p=0.002),而解剖学一级病变与更好的视力相关(71.5%,95CI=63.7-79.4;p=0.003)和突起(60.1%,95CI=38.0-82.2;p=0.001)回收率。手术入路之间的PFS率没有显着差异。
结论:SOM的手术治疗旨在保持视觉功能和改善眼球突出。不同的手术方法提供不同的GTR率,并发症,和功能结果。涉及颅底团队的多学科方法对于优化患者预后至关重要。
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.
OBJECTIVE: 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.
CONCLUSIONS: 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.