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Surgical Treatment of Spheno-Orbital Meningiomas: A Systematic Review and Meta-Analysis of Surgical Techniques and Outcomes

Background: Spheno-orbital meningiomas (SOMs) are rare tumors arising from the meninges surrounding the sphenoid bone and orbital structures. Surgical resection is the primary treatment approach for SOMs. Several surgical approaches have been described during the decades, including microsurgical tra...

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Autores principales: Agosti, Edoardo, Zeppieri, Marco, De Maria, Lucio, Mangili, Marcello, Rapisarda, Alessandro, Ius, Tamara, Spadea, Leopoldo, Salati, Carlo, Tel, Alessandro, Pontoriero, Antonio, Pergolizzi, Stefano, Angileri, Filippo Flavio, Fontanella, Marco Maria, Panciani, Pier Paolo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10531637/
https://www.ncbi.nlm.nih.gov/pubmed/37762781
http://dx.doi.org/10.3390/jcm12185840
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author Agosti, Edoardo
Zeppieri, Marco
De Maria, Lucio
Mangili, Marcello
Rapisarda, Alessandro
Ius, Tamara
Spadea, Leopoldo
Salati, Carlo
Tel, Alessandro
Pontoriero, Antonio
Pergolizzi, Stefano
Angileri, Filippo Flavio
Fontanella, Marco Maria
Panciani, Pier Paolo
author_facet Agosti, Edoardo
Zeppieri, Marco
De Maria, Lucio
Mangili, Marcello
Rapisarda, Alessandro
Ius, Tamara
Spadea, Leopoldo
Salati, Carlo
Tel, Alessandro
Pontoriero, Antonio
Pergolizzi, Stefano
Angileri, Filippo Flavio
Fontanella, Marco Maria
Panciani, Pier Paolo
author_sort Agosti, Edoardo
collection PubMed
description Background: Spheno-orbital meningiomas (SOMs) are rare tumors arising from the meninges surrounding the sphenoid bone and orbital structures. Surgical resection is the primary treatment approach for SOMs. Several surgical approaches have been described during the decades, including microsurgical transcranial (MTAs), endoscopic endonasal (EEAs), endoscopic transorbital (ETOAs), and combined approaches, and the choice of surgical approach remains a topic of debate. Purpose: This systematic review and meta-analysis aim to compare the clinical and surgical outcomes of different surgical approaches used for the treatment of SOMs, discussing surgical techniques, outcomes, and factors influencing surgical decision making. Methods: A comprehensive literature review of the databases PubMed, Ovid MEDLINE, and Ovid EMBASE was conducted for articles published on the role of surgery for the treatment of SOMs until 2023. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Meta-analysis was performed to estimate pooled event rates and assess heterogeneity. Fixed- and random-effects were used to assess 95% confidential intervals (CIs) of presenting symptoms, outcomes, and complications. Results: A total of 59 studies comprising 1903 patients were included in the systematic review and meta-analysis. Gross total resection (GTR) rates ranged from 23.5% for ETOAs to 59.8% for MTAs. Overall recurrence rate after surgery was 20.7%. Progression-free survival (PFS) rates at 5 and 10 years were 75.5% and 49.1%, respectively. Visual acuity and proptosis improvement rates were 57.5% and 79.3%, respectively. Postoperative cranial nerve (CN) focal deficits were observed in 20.6% of cases. The overall cerebro-spinal fluid (CSF) leak rate was 3.9%, and other complications occurred in 13.9% of cases. MTAs showed the highest GTR rates (59.8%, 95%CI = 49.5–70.2%; p = 0.001) but were associated with increased CN deficits (21.0%, 95%CI = 14.5–27.6%). ETOAs had the lowest GTR rates (23.5%, 95%CI = 0.0–52.5%; p = 0.001), while combined ETOA and EEA had the highest CSF leak rates (20.3%, 95%CI = 0.0–46.7%; p = 0.551). ETOAs were associated with better proptosis improvement (79.4%, 95%CI = 57.3–100%; p = 0.002), while anatomical class I lesions were associated with better visual acuity (71.5%, 95%CI = 63.7–79.4; p = 0.003) and proptosis (60.1%, 95%CI = 38.0–82.2; p = 0.001) recovery. No significant differences were found in PFS rates between surgical approaches. Conclusion: Surgical treatment of SOMs aims to preserve visual function and improve proptosis. Different surgical approaches offer varying rates of GTR, complications, and functional outcomes. A multidisciplinary approach involving a skull base team is crucial for optimizing patient outcomes.
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spelling pubmed-105316372023-09-28 Surgical Treatment of Spheno-Orbital Meningiomas: A Systematic Review and Meta-Analysis of Surgical Techniques and Outcomes Agosti, Edoardo Zeppieri, Marco De Maria, Lucio Mangili, Marcello Rapisarda, Alessandro Ius, Tamara Spadea, Leopoldo Salati, Carlo Tel, Alessandro Pontoriero, Antonio Pergolizzi, Stefano Angileri, Filippo Flavio Fontanella, Marco Maria Panciani, Pier Paolo J Clin Med Systematic Review Background: Spheno-orbital meningiomas (SOMs) are rare tumors arising from the meninges surrounding the sphenoid bone and orbital structures. Surgical resection is the primary treatment approach for SOMs. Several surgical approaches have been described during the decades, including microsurgical transcranial (MTAs), endoscopic endonasal (EEAs), endoscopic transorbital (ETOAs), and combined approaches, and the choice of surgical approach remains a topic of debate. Purpose: This systematic review and meta-analysis aim to compare the clinical and surgical outcomes of different surgical approaches used for the treatment of SOMs, discussing surgical techniques, outcomes, and factors influencing surgical decision making. Methods: A comprehensive literature review of the databases PubMed, Ovid MEDLINE, and Ovid EMBASE was conducted for articles published on the role of surgery for the treatment of SOMs until 2023. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Meta-analysis was performed to estimate pooled event rates and assess heterogeneity. Fixed- and random-effects were used to assess 95% confidential intervals (CIs) of presenting symptoms, outcomes, and complications. Results: A total of 59 studies comprising 1903 patients were included in the systematic review and meta-analysis. Gross total resection (GTR) rates ranged from 23.5% for ETOAs to 59.8% for MTAs. Overall recurrence rate after surgery was 20.7%. Progression-free survival (PFS) rates at 5 and 10 years were 75.5% and 49.1%, respectively. Visual acuity and proptosis improvement rates were 57.5% and 79.3%, respectively. Postoperative cranial nerve (CN) focal deficits were observed in 20.6% of cases. The overall cerebro-spinal fluid (CSF) leak rate was 3.9%, and other complications occurred in 13.9% of cases. MTAs showed the highest GTR rates (59.8%, 95%CI = 49.5–70.2%; p = 0.001) but were associated with increased CN deficits (21.0%, 95%CI = 14.5–27.6%). ETOAs had the lowest GTR rates (23.5%, 95%CI = 0.0–52.5%; p = 0.001), while combined ETOA and EEA had the highest CSF leak rates (20.3%, 95%CI = 0.0–46.7%; p = 0.551). ETOAs were associated with better proptosis improvement (79.4%, 95%CI = 57.3–100%; p = 0.002), while anatomical class I lesions were associated with better visual acuity (71.5%, 95%CI = 63.7–79.4; p = 0.003) and proptosis (60.1%, 95%CI = 38.0–82.2; p = 0.001) recovery. No significant differences were found in PFS rates between surgical approaches. Conclusion: Surgical treatment of SOMs aims to preserve visual function and improve proptosis. Different surgical approaches offer varying rates of GTR, complications, and functional outcomes. A multidisciplinary approach involving a skull base team is crucial for optimizing patient outcomes. MDPI 2023-09-08 /pmc/articles/PMC10531637/ /pubmed/37762781 http://dx.doi.org/10.3390/jcm12185840 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Agosti, Edoardo
Zeppieri, Marco
De Maria, Lucio
Mangili, Marcello
Rapisarda, Alessandro
Ius, Tamara
Spadea, Leopoldo
Salati, Carlo
Tel, Alessandro
Pontoriero, Antonio
Pergolizzi, Stefano
Angileri, Filippo Flavio
Fontanella, Marco Maria
Panciani, Pier Paolo
Surgical Treatment of Spheno-Orbital Meningiomas: A Systematic Review and Meta-Analysis of Surgical Techniques and Outcomes
title Surgical Treatment of Spheno-Orbital Meningiomas: A Systematic Review and Meta-Analysis of Surgical Techniques and Outcomes
title_full Surgical Treatment of Spheno-Orbital Meningiomas: A Systematic Review and Meta-Analysis of Surgical Techniques and Outcomes
title_fullStr Surgical Treatment of Spheno-Orbital Meningiomas: A Systematic Review and Meta-Analysis of Surgical Techniques and Outcomes
title_full_unstemmed Surgical Treatment of Spheno-Orbital Meningiomas: A Systematic Review and Meta-Analysis of Surgical Techniques and Outcomes
title_short Surgical Treatment of Spheno-Orbital Meningiomas: A Systematic Review and Meta-Analysis of Surgical Techniques and Outcomes
title_sort surgical treatment of spheno-orbital meningiomas: a systematic review and meta-analysis of surgical techniques and outcomes
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10531637/
https://www.ncbi.nlm.nih.gov/pubmed/37762781
http://dx.doi.org/10.3390/jcm12185840
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