Ekstrakraniyal uzanımı olan menengiomların tedavisinin zorlukları: Klinik çalışma

Year 2022, Volume: 13 Issue: 47, 361 - 369, 15.12.2022

Ali Genç Yener Akyuva Serdar Kabataş

https://doi.org/10.17944/mkutfd.1060518

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

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

References

• Rohringer M, Sutherland GR, Louw DF, Sima AA. Incidence and clinicopathological features of meningioma. J Neurosurg 1989;71(5):665-672. https://doi.org/10.3171/jns.1989.71.5.0665.
• Shah S, Gonsai RN, Makwana R. Histopathological study of meningioma in civil hospital, ahmedabad. Int J Cur Res Rev2013;5(3):76.
• Liu Y, Wang H, Shao H, Wang C. Primary extradural meningiomas in head: a report of 19 cases and review of literature. Int J Clin Exp Pathol 2015;8(5):5624.
• Maroon JC, Kennerdell JS, Vidovich DV, Abla A, Sternau L. Recurrent spheno-orbital meningioma. J Neurosurg 1994;80(2):202-208. https://doi.org/10.3171/jns.1994.80.2.0202.
• Boari N, Gagliardi F, Spina A, Bailo M, Franzin A, Mortini P. Management of spheno-orbital en plaque meningiomas: clinical outcome in a consecutive series of 40 patients. Br J Neurosurg 2013;27(1):84-90. https://doi.org/10.3109/02688697.2012.709557.
• Pinting L, Xiaofeng H, Zhiyong W, Wei H. Extracranial meningioma in the maxillary region. J CraniofacSurg 2013;24(2):142-144. https://doi.org/10.1097/SCS.0b013e31827c7e9f.
• Bassiouni H, Asgari S, Hübschen, U, König HJ, Stolke D. Dural involvement in primary extradural meningiomas of the cranial vault. J Neurosurg 2006;105(1):51-59. https://doi.org/10.3171/jns.2006.105.1.51.
• Genç A, Bicer A, Abacioglu U, Peker S, Pamir MN, Kilic T: Gamma knife radiosurgery for the treatment of glomusjugulare tumors. J Neurooncol 2010;97(1):101-108. https://doi.org/10.1007/s11060-009-0002-6.
• Muthukumar N. Primary calvarial meningiomas. Br J Neurosurg 1997;11:388-392. https://doi.org/10.1080/02688699745862.
• Maeng JW, Kim YH, Seo J, Kim SW. Primary extracranial meningioma presenting as a cheek mass. ClinExpOtorhinolaryngol 2013;6(4):266-268. https://doi.org/10.3342/ceo.2013.6.4.266.
• Batsakis JG. Pathology consultation: extracranial meningiomas. Ann OtolRhinolLaryngol 1984;93:282-283. https://doi.org/10.1177/000348948409300321.
• Pasqualetto L, Scuotto A, Guarnieri G, D’Avanzo R, Natale M, Rotondo M et al.. Meningiomas with unusual intraextracranial extension: ectopic entities?. Report of Two Cases and Literature Review. Surg Neurol 2004;17(4):573-579. https://doi.org/10.1177/ 197140090401700412.
• Cech DA, Leavens ME, Larson DL. Giant intracranial and extracranial meningioma: case report and review of the literature. Neurosurg 1982;11(5):694-697. https://doi.org/10.1227/00006123-198211000-00015.
• Nadkarni T, Desai K, Goel A. Giant meningioma of the cranial vertex-case report. Neurol Med Chir (Tokyo) 2002;42(3):128-131. https://doi.org/10.2176/nmc.42.128.
• Chan RC, Thompson GB. Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. J Neurosurg 1984;60:52-60. https://doi.org/10.3171/jns.1984.60.1.0052.
• Tuna M, Göçer AI, Gezercan Y, Vural A, Ildan F, Haciyakupoglu S et al.. Huge meningiomas: a review of 93 cases. Skull Base Surg 1999;9(3):227-238. https://doi.org/10.1055/s-2008-1058151.
• Rushing EJ, Bouffard JP, McCall S, Olsen C, Mena H, Sandberg GD et al. Primary extracranial meningiomas: an analysis of 146 cases. Head Neck Pathol 2009;3:116-130. https://doi.org/10.1007/s12105-009-0118-1.
• Thompson LD, Gyure KA: Extracranial sinonasal tract meningiomas: a clinicopathologic study of 30 cases with a review of the literature. Am J SurgPathol 2000;24:640-650. https://doi.org/10.1097/00000478-200005000-00002.
• Thompson LD, Bouffard JP, Sandberg GD, Mena H. Primary Ear and temporal bone meningiomas: a clinicopathological study of 36 cases with a review of the literature. Mod Pathol 2003;16:236-245. https://doi.org/10.1097/01. MP.0000056631.15739.1B.
• Bruninx L, Govaere F, Van Dorpe J, Forton GE. Isolated synchronous meningioma of the external ear canal and the temporal lobe. B-ENT 9(2):157-60, 201321. Grover SB, Aggarwal A, ShingUppal P. The CT triad of malignancy in meningiomaredefinition, with a report of three new cases. Neuroradiology 2003;45:799-803. https://doi.org/10.1007/s00234-003-1070-5.
• Possanzini P, Pipolo C, Romagnoli S, Falleni M, Moneghini L, Braidotti P et al.. Primary extracranial meningioma of head and neck: clinical, histopathological and immunohistochemical study of three cases. Acta Otorhinolaryngol Ital 2012;32(5):336-338.
• Taki N, Wein RO, Bedi H, Heilman CB. Extracranial Intraluminal Extension of Atypical Meningioma within the Internal Jugular Vein. Case Rep Otolaryngol 2013;875607. https://doi.org/10.1155/2013/875607.
• Zhang Q, Wang Z, Guo H, Kong F, Chen G, Bao Y et al. Resection of anterior cranial base meningiomas with intra and extracranial involvement via a purely endoscopic endonasal approach. ORL J Otorhinolaryngol Relat Spec 2012;74(4):199-207.
• Morokoff AP, Zauberman J, Black PM. Surgery for convexity meningiomas. Neurosurg 2008;63(3):427-434. https://doi.org/10.1227/01.NEU.0000310692.80289.28.
• Lang FF, McDonald KO, Fuller GN. Primary extradural meningiomas: a report of nine cases and review of the literature from the era of computerized tomography scanning. J Neurosurg 2000;93:940-950. https://doi.org/10.3171/jns.2000.93.6.0940.
• Arana E, Diaz C, Latorre FF. Primary intraosseous meningiomas. Acta Radiologica 1998;37: 937-42. https://doi.org/10.1177/02841851960373P299.
• Wang H, Niu S, Wang C, Liu Y. Clinical Features and Surgical Treatment of Aggressive Meningiomas. Turk Neurosurg 2015;25:690-694. https://doi.org/10.5137/1019-5149. JTN.10714-14.1.
• Oka K. Hirakawa K. Yoshida S. Primary calvarial meningiomas. Surg Neurol 1989;32:304-310. https://doi.org/10.1016/0090-3019(89)90235-8.
• Oka K, Tomonaga M, Hirakawa K: Primary calvarial meningiomas, in Schmidek HH (ed). Meningiomas and Their Surgical Management. Philadelphia. WB Saunders;1991;191-202.
• Qasho R, Celli P. Ectopic dural osteolytic meningiomas. Neurosurg Rev 1998;21:295-298. https://doi.org/10.1007/BF01105789.
• Barbaro NM, Gutin PH, Wilson CB, Sheline GE, Boldrey EB, Wara WM. Radiation therapy in the treatment of partially resected meningiomas. Neurosurgery 1987;20(4):525-528. https://doi.org/10.1227/00006123-198704000-00003.
• Engelhard HH. Progress in the diagnosis and treatment of patients with meningiomas: Part i: diagnostic imaging, preoperative embolization. Surg Neurol 2001;55(2):89-101. https://doi.org/10.1016/s0090-3019(01)00349-4.