Ekstrakraniyal uzanımı olan menengiomların tedavisinin zorlukları: Klinik çalışma

Abstract

Objective: Surgical treatment of extracranial meningiomas is challenging. In this study, we present an illustrated case series to share our experience in the treatment of meningiomas with extracranial extension.
 
 Method: We retrospectively reviewed the data of 11 patients with meningiomas who underwent surgical treatment between 2008 and 2020. The intracranial and extracranial components were radiologically and intraoperatively confirmed for all patients.
 
 Results: The patients included seven men and four women with a mean age of 55.4 years. Most patients presented with facial disfigurement or asymmetrical skull growth. The most common symptom at presentation was headache. The most common location of the meningiomas was the frontal region and those of extracranial growth were the paranasal sinuses and parietal bone invasion. We recognized two distinct modalities of bone destruction: hyperostosis (n=3) and osteolysis (n=8). Pathological investigation revealed atypical features in six patients. Preoperative embolization was attempted in four patients but it proved to be difficult; proper embolization could be achieved only in one patient. The most commonly encountered challenges during surgery were large calvarial and cranial base defects due to bone erosion, dural defects, and managing the superior sagittal sinus with parietal tumors. Excessive blood loss was also of particular concern, which was managed using simple scalp clips, intraoperative transfusion, and other conservative approaches of tumor extensions into paranasal sinuses. No perioperative mortality occurred. Calvarial reconstruction was performed with polymethyl methacrylate cement where needed.
 
 Conclusion: Meningiomas with extracranial extension are surgically challenging but treatable. It contains fine neurosurgical trics in its treatment and follow-up.