目的:本研究旨在确定影响蝶眶脑膜瘤(SOM)手术中眼球突出恢复的因素,并评估功能和肿瘤预后。
方法:分析了来自32例连续SOM手术病例(2002-2021)的数据。临床,放射学,Operative,和肿瘤参数进行了检查。使用MRI或CT扫描的眼球突出指数(EI)评估眼球下垂。进行统计分析以确定突增恢复的预测因素。
结果:75%的患者在手术后有改善(EI从1.28±0.16下降到1.20±0.13,p=0.048)。EI稳定或恶化的患者体重指数较高(28.5±7.9vs.24.1±4.7,p=0.18),辛普森等级(IV75%vs.65%,p=0.24),和蝶骨中翼震中受累(63%vs.38%,p=0.12),但与眼球突出不良结局无显著相关因素.改善组有更高的斑块形态,颞下窝侵入,和放射治疗海绵窦残留肿瘤(88%vs.75%,p=0.25;51%vs.25%,p=0.42;41%vs.25%,分别为p=0.42),但没有统计学意义。视力稳定在78%,提高了13%,在随访期间恶化了9%。4例患者中有3例(75%)手术对术前动眼神经功能障碍具有积极影响。术后观察到25%的动眼神经功能障碍,其中75%完全恢复。这种情况与眼眶肿瘤残留物的照射显着相关(p=0.04)。术后新的三叉神经感觉减退观察到47%,其中73%已恢复。所有SOM被归类为WHO1级,补充治疗实现了肿瘤控制,需要伽玛刀放射外科的53%和标准放射治疗的6%。
结论:手术可有效改善SOM的眼球突出,虽然完整的决议是罕见的。缺乏预测因素表明是多因素的原因,包括体重指数和肿瘤切除等级。术后动眼神经功能障碍和三叉神经感觉减退很常见,但通常会恢复。伽玛刀放射外科对不断发展的肿瘤残留物保持长期的肿瘤控制。
OBJECTIVE: This study aimed to identify factors affecting
proptosis recovery in spheno-orbital meningioma (SOM) surgery and assess functional and oncological outcomes.
METHODS: Data from 32 consecutive SOM surgery cases (2002-2021) were analyzed. Clinical, radiological, operative, and oncological parameters were examined.
Proptosis was assessed using the exophthalmos index (EI) on MRI or CT scans. Statistical analyses were performed to identify predictive factors for
proptosis recovery.
RESULTS: Proptosis improved in 75% of patients post-surgery (EI decreased from 1.28 ± 0.16 to 1.20 ± 0.13, p = 0.048). Patients with stable or worsened EI had higher body mass index (28.5 ± 7.9 vs. 24.1 ± 4.7, p = 0.18), Simpson grade (IV 75% vs. 65%, p = 0.24), and middle sphenoid wing epicenter involvement (63% vs. 38%, p = 0.12), but no significant factors were associated with unfavorable exophthalmos outcomes. The improvement group had higher en plaque morphology, infratemporal fossa invasion, and radiation treatment for cavernous sinus residual tumor (88% vs. 75%, p = 0.25; 51% vs. 25%, p = 0.42; 41% vs. 25%, p = 0.42, respectively), but without statistical significance. Visual acuity remained stable in 78%, improved in 13%, and worsened in 9% during follow-up. Surgery had a positive impact on preoperative oculomotor nerve dysfunction in 3 of 4 patients (75%). Postoperative oculomotor nerve dysfunction was observed in 25%, of which 75% fully recovered. This occurrence was significantly associated with irradiation of an orbital tumor residue (p = 0.04). New postoperative trigeminal hypoesthesia was observed in 47%, of which 73% recovered. All SOMs were classified as WHO grade 1, and complementary treatments achieved oncological control, requiring gamma-knife radiosurgery in 53% and standard radiotherapy in 6%.
CONCLUSIONS: Surgery effectively improves
proptosis in SOM, though complete resolution is rare. The absence of predictive factors suggests multifactorial causes, including body mass index and tumor resection grade. Postoperative oculomotor nerve dysfunction and trigeminal hypoesthesia are common but often recover. Gamma-knife radiosurgery maintains long-term oncological control for evolving tumor residue.