背景:海绵窦脑膜瘤(CSM)由于靠近重要的神经血管结构而具有挑战性。传统的侵袭性经颅切除术通常会导致严重的发病率,而脑神经(CN)缺陷的改善有限。内窥镜颅底手术和立体定向放射治疗(SRT)的最新进展提供了更保守的方法,促进肿瘤减压,同时保留关键结构。
方法:这项回顾性研究回顾了有症状的CSM患者接受内镜经鼻和/或经眶手术的病历,其次是佐剂SRT,2017年1月至2022年4月期间在我们的机构。患者人口统计学,肿瘤特征,手术方法,辐射,治疗结果,并发症,并对随访时间进行分析。
结果:纳入39例CSM患者。24例患者(61.5%)进行了鼻内镜入路(EEA),内镜经眶入路(ETOA)10例(25.6%),5例患者(15.2%)合并入路。对79.5%的患者施用辅助SRT。术后结果显示,在60.8%和65%的病例中,CN3-6缺陷和视力恢复。分别。并发症包括术后CN3-6缺陷5例,辐射后视力恶化1例。在平均44个月的随访期间,肿瘤进展发生在4例患者中(12%),其中3例诊断为WHOII级脑膜瘤,1例诊断为WHOI级。
结论:本研究支持使用内窥镜颅底手术联合辅助SRT治疗有症状的CSM,证明安全性和有效性。这种方法在症状改善方面产生了有利的结果,肿瘤控制,和积极的安全形象。
BACKGROUND: Cavernous sinus meningiomas (CSMs) are challenging skull base tumors due to their proximity to vital neurovascular structures. Traditional aggressive transcranial resection often leads to significant morbidities with limited improvement of cranial nerve (CN) deficits. Recent advancements in endoscopic skull base surgery and stereotactic radiation therapy (SRT) offer a more conservative approach, facilitating tumor decompression while preserving critical structures.
METHODS: This retrospective study reviewed medical records of patients with symptomatic CSMs who underwent endoscopic endonasal and/or transorbital surgery, followed by adjuvant SRT, at our institution between January 2017 and April 2022. Patient demographics, tumor characteristics, surgical approaches, radiation, treatment outcomes, complications, and follow-up time were analyzed.
RESULTS: Thirty nine patients with CSMs were included. Endoscopic endonasal approach (EEA) was performed in 24 patients (61.5%), endoscopic transorbital approach (ETOA) in 10 patients (25.6%), and combined approaches in 5 patients (15.2%). Adjuvant SRT was administered to 79.5% of patients. Postoperative outcomes showed recovery of CN 3-6 deficits and vision in 60.8% and 65% of cases, respectively. Complications included postoperative CN 3-6 deficits in 5 cases, and post-radiation visual deterioration in 1 case. During a mean follow-up period of 44 months, tumor progression occurred in 4 patients (12%), with 3 diagnosed as WHO grade II meningiomas and 1 as WHO grade I.
CONCLUSIONS: This study supports the use of endoscopic skull base surgery combined with adjuvant SRT for symptomatic CSMs, demonstrating both safety and efficacy. This approach yielded favorable outcomes in symptom improvement, tumor control, and positive safety profile.