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Year : 2018  |  Volume : 35  |  Issue : 3  |  Page : 287-296

Orbitozygomatic approach results of 16 spheno-orbital hyperostotic meningiomas (en plaque)

1 Department of Neurological Surgery, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt
2 Department of Pathology, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt
3 Department of Radiology, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt

Correspondence Address:
Dr. Ashraf El Badry
Department of Neurological Surgery, Faculty of Medicine, Mansoura University Hospital, Mansoura, 35516
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bmfj.bmfj_119_17

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Objective This study aimed to evaluate the results of the orbitozygomatic approaches of intraosseous meningiomas that causes hyperostoses involving the greater wing of the sphenoid and orbital bones with a small soft tissue component. Patients and methods We carried out a prospective and retrospective study of 16 patients with meningiomas en plaque who underwent surgical procedures by the orbitozygomatic approach in the period between 1999 and 2014 at the Neurological Surgery Department, Mansoura University Hospital of Egypt. Results The mean age of the patients was 49.6 years, whereas the most common complaint was proptosis accounting for 81.25% of cases. The second most common complaint was visual impairment accounting for 56.25% of cases. The orbitozygomatic approach was used for all the cases and drilling of the greater wing of the sphenoid, lateral orbital wall, orbital, and optic canal roof was performed. The small soft tissue component of the meningiomas was in the anterior and middle cranial fossa involving hyperostoses in all surrounding bones in all cases, whereas four cases showed intraorbital soft tissue meningioma. The results after surgery indicated an improvement of proptosis in 75% of cases, with less improvement in visual impairment observed in 56.25% of cases. Complications included third nerve palsy in 87.25% (14) of cases, and improved only in five cases. The extent of tumor surgical resection was subtotal in 75% (12) of cases. These tumors progressed in eight cases and only two patients underwent a second surgical intervention; others were referred to radiotherapy. Conclusion Despite good surgical exposure in this approach, the radical excision of the tumors may be extremely difficult as the tumor in these areas showed involvement of very delicate structures (because of late medical consultation), which made the dissection impossible, but using this approach we can achieve good results including proptosis and visual impairment.

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