Raywat Noiphithak, Juan C Yanez-Siller, Pree Nimmannitya, Pornchai Yodwisithsak
{"title":"优化海绵窦脑膜瘤的治疗:内窥镜鼻内镜和经眶手术与辅助立体定向放射治疗相结合的新策略","authors":"Raywat Noiphithak, Juan C Yanez-Siller, Pree Nimmannitya, Pornchai Yodwisithsak","doi":"10.1016/j.wneu.2024.08.164","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Thirty-nine patients with CSMs were included. Endoscopic endonasal approach was performed in 24 patients (61.5%), endoscopic transorbital approach in 10 patients (25.6%), and combined approaches in 5 patients (12.8%). Adjuvant SRT was administered to 79.5% of patients. Postoperative outcomes showed recovery of CN 3-6 deficits and vision in 60.9% and 65% of cases, respectively. Complications included postoperative CN 3-6 deficits in 5 cases and postradiation visual deterioration in 1 case. During a mean follow-up period of 44 months, tumor progression occurred in 4 patients (10.3%), with 3 diagnosed as World Health Organization grade II meningiomas and 1 as World Health Organization grade I.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"e538-e546"},"PeriodicalIF":1.9000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Optimizing Management of Cavernous Sinus Meningiomas: A Novel Strategy Integrating Endoscopic Endonasal and Transorbital Surgery with Adjuvant Stereotactic Radiotherapy.\",\"authors\":\"Raywat Noiphithak, Juan C Yanez-Siller, Pree Nimmannitya, Pornchai Yodwisithsak\",\"doi\":\"10.1016/j.wneu.2024.08.164\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Thirty-nine patients with CSMs were included. Endoscopic endonasal approach was performed in 24 patients (61.5%), endoscopic transorbital approach in 10 patients (25.6%), and combined approaches in 5 patients (12.8%). Adjuvant SRT was administered to 79.5% of patients. Postoperative outcomes showed recovery of CN 3-6 deficits and vision in 60.9% and 65% of cases, respectively. Complications included postoperative CN 3-6 deficits in 5 cases and postradiation visual deterioration in 1 case. During a mean follow-up period of 44 months, tumor progression occurred in 4 patients (10.3%), with 3 diagnosed as World Health Organization grade II meningiomas and 1 as World Health Organization grade I.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":23906,\"journal\":{\"name\":\"World neurosurgery\",\"volume\":\" \",\"pages\":\"e538-e546\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.wneu.2024.08.164\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/5 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.wneu.2024.08.164","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/5 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Optimizing Management of Cavernous Sinus Meningiomas: A Novel Strategy Integrating Endoscopic Endonasal and Transorbital Surgery with Adjuvant Stereotactic Radiotherapy.
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 was performed in 24 patients (61.5%), endoscopic transorbital approach in 10 patients (25.6%), and combined approaches in 5 patients (12.8%). Adjuvant SRT was administered to 79.5% of patients. Postoperative outcomes showed recovery of CN 3-6 deficits and vision in 60.9% and 65% of cases, respectively. Complications included postoperative CN 3-6 deficits in 5 cases and postradiation visual deterioration in 1 case. During a mean follow-up period of 44 months, tumor progression occurred in 4 patients (10.3%), with 3 diagnosed as World Health Organization grade II meningiomas and 1 as World Health Organization 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.
期刊介绍:
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS