Abstract
BackgroundIntraosseous growth is a unique feature of sphenoorbital meningiomas (SOM). Its close relation to neurovascular structures limits complete surgical resection and possibly contributes to the high recurrence rate.ObjectiveTo evaluate the growth behavior of intraosseous remnants and develop a protocol for precise intraoperative visualization of intraosseous SOM.MethodsWe included 31 patients operated for SOM from 2004 to 2017. The growth velocity of the intraosseous tumor component was volumetrically calculated in 20 cases. To improve accuracy of image guidance, we implemented a specialized bone surface-based registration algorithm. For intraoperative bone visualization, we included CT in multimodality continuous image guidance in 23 patients. The extent of resection (EOR) was compared with a standard MR-only navigation group (n = 8).ResultsIn 11/20 cases (55%), a progressive regrowth of the intraosseous SOM remnant was noted during a mean follow-up of 52 months (range 20–132 months). We observed a mean increase of 6.2 cm3 (range 0.2–23.7 cm3) per patient and side during the follow-up period. Bone surface-based registration was significantly more accurate than skin surface-based registration (mean 0.7 ± 0.4 mm and 1.9 ± 0.7 mm, p < 0.001). The EOR of the intraosseous component was significantly higher using CT + MRI navigation compared with controls (96% vs. 81%, p = 0.044).ConclusionQuantitative assessment of the biological behavior of intraosseous remnants revealed a continuous slow growth rate independent of the soft tumor component of more than half of SOM. According to our data, application of a multimodal image guidance provided high accuracy and significantly increased the resection rate of the intraosseous component of SOM.
Highlights
Surgical removal: all sphenoorbital meningiomas (SOM) resections were performed by standard microsurgical technique including high-speed diamond drill under neuronavigational guidance by senior surgeons
Of all 31 patients, 23 (74%) were operated with the image guidance protocol; the remaining 8 (26%) operated with magnetic resonance (MR)-only navigation served as controls
For the intraosseous tumor component, extent of resection (EOR) was significantly higher using the navigation protocol compared with MR-only navigation (96% vs. 81% respectively, p = 0.044), but not for the soft tumor component
Summary
Apart from their dural component, sphenoorbital meningiomas (SOM) exhibit a unique intraosseous growth pattern within and adjacent to the sphenoid bone closely related to skull base neurovascular structures limiting surgical resection. The main goals of neurosurgical SOM treatment are improvement/prevention of visual impairment and reversal of exophthalmos by decompression of optochiasmatic and orbital structures from affected bone and soft tumor component. Concerning the intraosseous component of SOM, extensions medial to the cranial nerve ostia of the middle cranial fossa render a Simpson °I resection virtually impossible from a standard pterional approach. Its close relation to neurovascular structures limits complete surgical resection and possibly contributes to the high recurrence rate
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