Challenges associated with meningiomas with extracranial extension: A clinical study

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.

Keywords

• Meningioma
• Extracranial
• Skull base defect
• Cranioplasty
• Paranasal sinus invasion
• Orbital invasion

Project Number

Yok

Ekstrakraniyal uzanımı olan menengiomların tedavisinin zorlukları: Klinik çalışma

Abstract

Amaç: Meningiomlar çoğunlukla intrakraniyal ve intradural yerleşimli benign tümörlerdir ancak nadiren ekstradural ve ekstrakraniyal büyüme gösterebilirler. Ekstrakraniyal meningiomların cerrahi tedavisi özellikli ve zordur. Bu çalışmada, ekstrakraniyal yayılımlı meningiomların tedavisindeki deneyimimizi aktarmak için cerrahi serimizi sunmayı amaçladık. Yöntem: 2008-2020 yılları arasında cerrahi uygulanan 11 meningiomlu hastayı retrospektif olarak inceledik. Bu hastalarda hem intrakraniyal hem de ekstrakraniyal uzanımı hem radyolojik hem de intraoperatif olarak doğrulandı. Bulgular: Hastaların ortalama yaşı 55.4 yıl olan 7 erkek ve 4 kadındı. Çoğu, yüz şekil bozukluğu veya kafataslarının asimetrik büyümesi ile kendini gösterdi. Başvuru anında en sık görülen semptom baş ağrısı olarak saptandı. Meningiomların en sık yerleşim yeri frontal bölgeydi ve ekstrakraniyal büyüme paranazal sinüsler ve parietal kemik invazyonuydu. İki farklı kemik yıkımı yöntemi belirledik: hiperostoz (n=3) ve osteoliz (n=8). Patolojik çalışma 6 hastada atipik özellikler ortaya koydu. Preop embolizasyon 4 hastada denendi ve zor olduğu görüldü. Sadece bir hastada uygun embolizasyon sağlandı. En sık karşılaşılan cerrahi zorluklar; kemik erozyonu, dural defektler ve parietal tümörler ile superior sagital sinüs invazyonu, büyük kalvarial ve kraniyal taban defektleriydi. Abondan kanamada cerrahi zorluk oluşturdu ve bu durum hemoklip, intraoperatif transfüzyon ve paranazal sinüslere tümör uzantıları için konservatif yaklaşımla çözümlendi. Perioperatif mortalite olmadı. Skalp altında oluşan postoperatif BOS fistülü yaygın komplikasyondu ancak baskılı bandaj ile konservatif olarak çözülebildi. Gerektiğinde PMMA sementi ile kalvarial rekonstrüksiyon yapıldı. Sonuç: Ekstrakraniyal yayılımlı meningiomlar cerrahi olarak zor ancak tedavi edilebilir tümörlerdir. Tedavi ve takibinde mikronöroşirürjikal cerrahi püf noktaları içerir

Keywords

• Meningiom
• Ekstrakraniyal
• Kafa tabanı defekti
• Kraniyoplasti
• Paranazal sinüs invazyonu
• Orbita invazyonu

Supporting Institution

Yok

Project Number

Yok

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