Soriano SJA, Soto GME, Solorio PS, Romero RJAI

Language: Spanish
References: 8
Page: 63-66
PDF size: 286.70 Kb.

ABSTRACT

Spheno-orbital meningiomas consist of two components: extensive sphenoid hyperostosis and intradural growth. The dural invasion often extends to the basal sphenoid wing, superior orbital fissure, cavernous sinus optic canal, infratemporal fossa and periotbitary structures. The purpose of this work is to demonstrate the surgical management of these patients, with the advantages of neuronavigation and 3D reconstruction of the cranial plate with sterolithography. A 46-year-old woman with a progressive decrease in visual acuity of the right eye after one year of evolution, subsequently showed a decrease in ocular mobility and deformity of the right eye. Simple and contrasted magnetic resonance of the brain showed extra-axial tumor dependent on the minor wing of the sphenoid of the right side with an extension in the plate to the orbital roof and the middle fossa, with an extra-conal intraorbital tumor component displacing intraocular structures, compatible with right spheno-orbital meningioma. Frontotemporal craniectomy was performed with right orbito-zygomatic osteotomy and sphenoid cleft decompression and optic hole, guided by neuronavigation (Simpson I), subsequently performing cranial defect reconstruction with 3D preformed methylmethacrylate plate. Spheno-orbital meningioma is a rare tumor of the base of the skull with intraosseous growth and hyperostosis that clinically in most cases manifests with proptosis, visual impairment. Aggressive tumor resection is important in order to avoid tumor recurrence and improve long-term prognosis.

REFERENCES

1. Gonen L, Nov E, Shimony N, Shofty B, Margalit N. Sphenoorbital meningioma: surgical series and design of an intraoperative management algorithm. Neurosurg Rev. 2018; 41 (1): 291-301.

2. Mariniello G, Bonavolonta G, Tranfa F, Maiuri F. Management of the optic canal invasion and visual outcome in spheno-orbital meningiomas. Clin Neurol Neurosurg. 2013; 115 (9): 1615-1620.

3. Nagahama A, Goto T, Nagm A, Tanoue Y, Watanabe Y, Arima H et al. Spheno-orbital meningioma: surgical outcomes and management of recurrence. World Neurosurgery. 2019; 126: e679-687. Available from: https://doi.org/10.1016/j.wneu.2019.02.123.

4. Castellano F, Guidetti B, Olivecrona H. Pterional meningiomas en plaque. J Neurosurg. 1952; 9 (2): 188-196.

5. Shrivastava RK, Sen C, Costantino PD, Della Rocca R. Sphenoorbital meningiomas: Surgical limitations and lessons learned in their long-term management. J Neurosurg. 2005; 103 (3): 491-497.

6. Bowers CA, Sorour M, Patel BC, Couldwell WT. Outcomes after surgical treatment of meningioma-associated proptosis. J Neurosurg. 2016; 125 (3): 544-550.

7. Essa AA, Hamdan AR. Sphenoid meningioma enplaque with proptosis: Surgical excision, reconstruction and outcome. Clin Neurol Neurosurg. 2018; 167: 147-156. Available from: https://doi.org/10.1016/j.clineuro.2018.02.028.

8. Buttrick S, Morcos JJ, Elhammady MS, Wang AC. Extradural clinoidectomy for resection of clinoidal meningioma. Neurosurg Focus. 2017; 43 (videosuppl2): V10. Available from: https://thejns.org/view/journals/neurosurg-focus/43/videosuppl2/2017.10.FocusVid.17363.xml.