背景:蝶眶脑膜瘤(SOM)代表蝶骨翼脑膜瘤的独特变体,以骨浸润和颅眶受累的倾向为特征。SOM表现出相当大的误诊和复发发生率。
目的:为了阐明临床,放射学,SOM的病理特征。
方法:电子病历审查,组织病理学,100例SOM患者的放射学图像和随访信息。
结果:在100名患者中(28名男性,72名女性)与SOM,平均年龄为46.8±12.6岁,主要症状为眼球突出(99%).所有CT扫描均显示骨肥大,其中89.3%的骨肥大边缘不规则。在核磁共振扫描中,所有患者均观察到硬脑膜尾征,颅眶肿瘤经常穿透颞部肌肉(74.1%),眼外肌(74.1%)和泪腺(63%)。所有100例患者都接受了手术干预,其中,62例患者接受术后放疗。Ⅰ级切除复发率较低(16.7%),随着放疗的增加,这一比例进一步下降(13.9%)。相比之下,所有II级或更高级别切除但未接受放疗的患者均出现复发,表明较高的风险与较不完全的肿瘤切除相关。病理检查显示,眶内切片显示与眶内SOM肿瘤相当的肿瘤密度,随着纤维密度增加,但血管分布减少。
结论:SOM的放射学特征包括颅眶肿瘤,蝶骨翼骨增生,边缘不规则,和硬脑膜尾部标志。建议全切和辅助放疗相结合,以最大程度地减少复发率。颅内SOM肿瘤倾向于比眶内切片更柔软,更容易出血,需要手术精度。
BACKGROUND: Spheno-orbital meningioma (SOM) represents a unique variant of sphenoid wing meningiomas, distinguished by its propensity for bone infiltration and cranio-orbital involvement. SOM exhibits a considerable incidence of misdiagnosis and recurrence.
OBJECTIVE: To elucidate the clinical, radiological, and pathological characteristics of SOM.
METHODS: Review of electronic medical records, histopathology, radiological images and follow-up information of 100 SOM patients.
RESULTS: Of the 100 patients (28 males, 72 females) with SOM, mean age was 46.8 ± 12.6 years and prevalent symptoms were proptosis (99%). All the CT scans showed hyperostosis with 89.3% of the hyperostosis having an irregular edge. In MRI scans, dural tail sign was observed across all patients and the cranio-orbital tumors often penetrated temporal muscle (74.1%), extraocular muscle (74.1%) and lacrimal gland (63%). All the 100 patients underwent surgical intervention, and among them, 62 individuals received postoperative radiotherapy. Grade I resections had a lower recurrence rate(16.7%), which further decreased with the addition of radiotherapy(13.9%). In contrast, all patients with grade II or higher grade resections without radiotherapy experienced recurrence, indicating a higher risk associated with less complete tumor removal. The pathological examination revealed that intraorbital sections exhibited comparable tumor density to intraorbital SOM tumors, along with increased fibrous density but decreased vascular distribution.
CONCLUSIONS: Radiological characteristics of SOM included cranio-orbital tumors, hyperostosis of the sphenoid wing with an irregular edge, and dural tail sign. Combination of gross total resection and adjuvant radiotherapy was recommended to minimize recurrence rate. Intracranial SOM tumors tended to be softer and more bleed-prone than intraorbital sections, necessitating surgical precision.