ABSTRACT
Introducción: los meningiomas del foramen óptico producen un rápido deterioro de la función visual aún cuando su tamaño es pequeño, por eso su diagnóstico y manejo difiere del resto de los meningiomas clinoideos. El propósito de este estudio es presentar la técnica y los resultados de nuestro manejo quirúrgico de meningiomas foraminales (MF). Pacientes y Métodos: se llevó a cabo una revisión de las historias clínicas de 47 pacientes con meningiomas primarios intraorbitarios. Se realizaron 52 cirugías en los pacientes con MF. Se empleó una craneotomía fronto-orbitaria, seguida de una descompresión extradural del canal óptico, resección del componente intraorbitario y exploración intradural del nervio óptico. Resultados: de los 12 pacientes con MF que presentaban la visión conservada, la agudeza visual fue preservada en 7 casos, mejoró en 2, y empeoró en 3. En 18 pacientes, el principal síntoma fue exoftalmos y en 35 pacientes ceguera unilateral. Ocurrieron 6 recurrencias, 2 a 10 años después de la resección quirúrgica. Cinco de ellos fueron reoperados. Se indicó radioterapia después de la recurrencia en 3 pacientes. Conclusión: el manejo de los MF continúa siendo controvertido y frecuentemente se propone un tratamiento conservador. Basados en nuestros hallazgos de frecuente extensión intracraneal, proponemos realizar una resección total o subtotal del tumor, preservando el nervio óptico en pacientes con visión prequirúrgica conservada.
Introduction: optic foramen meningiomas produce rapid deterioration of visual function even when its size is small, so its diagnosis and management differs from other clinoidal meningiomas. The purpose of this study is to present the technique and results of our surgical management of foraminal meningiomas (FM).Patients and Methods: a review of medical records of 47 patients harboring primary intraorbital meningiomas (PIM) was performed. In PIM patients fifty two operations were carried out. Fronto-orbital craniotomy was employed followed by extradural decompression of the optic canal, resection of the intraorbital component, and exploration of the optic nerve intradurally.Results: among 12 patients with PIM who had useful vision preoperatively the visual acuity was preserved in 7 cases, improved in 2, and worsened in 3 cases. In 18 patients exophthalmos was the main symptom and in 35 patients unilateral blindness. Six recurrences occurred 2 to 10 years after surgery. Five of them were reoperated on. We indicated radiotherapy after recurrence in 3 patients.Conclusion: the management of PIM remains controversial and conservative management is frequently proposed. Based on our frequent findings of intracranial extension, our approach has been to perform a total or subtotal removal of the tumor, sparing the optic nerve in patients with useful preoperative vision.
Subject(s)
Humans , Meningioma , Optic NerveABSTRACT
PURPOSE: This study investigated the anatomy of the anterior ethmoidal foramen, posterior ethmoidal foramen, optic foramen, and nasolacrimal duct located in the medial orbit. METHODS: The subjects of this investigation were 20 eyes of 10 cadavers, three were male and seven were female. After exenteration, anatomic evaluation of medial orbit and nasolacrimal duct were performed. The results were verified by Mann-Whitney U test. RESULTS: The distance from the posterior lacrimal crest is 16.10+/-1.07 mm to the anterior ethmoidal foramen, 30.35+/-4.08 mm to the posterior ethmoidal foramen and 37.40+/-2.03 mm to the optic foramen. The distance is 13.95+/-1.16 mm between the anterior and posterior ethmoidal foramen, 6.45+/-1.86 mm between the posterior ethmoidal foramen and optic foramen. The distance from the anterior ethmoidal foramen to its vertical contact point from the anterior ethmoidal foramen to the base line between the posterior lacrimal crest and optic foramen is 14.68+/-2.56 mm, from This vertical contact point to the posterior lacrimal crest is 4.00+/-1.35 mm and the angle between line from the anterior ethmoidal foramen to the posterior lacrimal crest and the line from the optic foramen to the posterior lacrimal crest is 16.15+/-7.03. The distance from the posterior ethmoidal foramen to its vertical contact point from the posterior ethmoidal foramen to the base line between the posterior lacrimal crest and optic foramen is 30.88+/-2.27 mm, from this vertical contact point to the posterior lacrimal crest is 2.30+/-0.71 mm and the angle between the line from the posterior ethmoidal foramen to the posterior lacrimal crest and the line from the optic foramen to the posterior lacrimal crest is 4.43+/-1.47. The total length is 33.55+/-5.34mm, the angle are 44.98+/-6.61 degrees between the coronal plane and 36.60+/-2.19 degrees between the sagittal palne in nasolacrimal duct. CONCLUSIONS: Our study evaluate normal anatomy of the medial orbit, suggest surgical index in Korean.