Challenging the osseous component of sphenoorbital meningiomas

Background Intraosseous growth is a unique feature of sphenoorbital meningiomas (SOM). Its close relation to neurovascular structures limits complete surgical resection and possibly contributes to the high recurrence rate. Objective To evaluate the growth behavior of intraosseous remnants and develo...

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Bibliographic Details
Published in:Acta neurochirurgica 2019-11, Vol.161 (11), p.2241-2251
Main Authors: Maschke, Svenja, Martínez-Moreno, Mauricio, Micko, Alexander, Millesi, Matthias, Minchev, Georgi, Mallouhi, Ammar, Knosp, Engelbert, Wolfsberger, Stefan
Format: Article
Language:English
Subjects:
Adult
Aged
Algorithms
Brain cancer
Female
Growth rate
Humans
Interventional Radiology
Magnetic resonance imaging
Magnetic Resonance Imaging - methods
Male
Medicine
Medicine & Public Health
Meningeal Neoplasms - diagnostic imaging
Meningeal Neoplasms - surgery
Meningioma - diagnostic imaging
Meningioma - surgery
Middle Aged
Minimally Invasive Surgery
Neurology
Neuroradiology
Neurosurgery
Orbital Neoplasms - diagnostic imaging
Orbital Neoplasms - surgery
Original - Tumor - Meningioma
Original Article - Tumor - Meningioma
Registration
Regrowth
Skin
Sphenoid Bone - diagnostic imaging
Surgical Orthopedics
Tumor – Meningioma
Visualization
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Summary:Background Intraosseous growth is a unique feature of sphenoorbital meningiomas (SOM). Its close relation to neurovascular structures limits complete surgical resection and possibly contributes to the high recurrence rate. Objective To evaluate the growth behavior of intraosseous remnants and develop a protocol for precise intraoperative visualization of intraosseous SOM. Methods We included 31 patients operated for SOM from 2004 to 2017. The growth velocity of the intraosseous tumor component was volumetrically calculated in 20 cases. To improve accuracy of image guidance, we implemented a specialized bone surface-based registration algorithm. For intraoperative bone visualization, we included CT in multimodality continuous image guidance in 23 patients. The extent of resection (EOR) was compared with a standard MR-only navigation group ( n  = 8). Results In 11/20 cases (55%), a progressive regrowth of the intraosseous SOM remnant was noted during a mean follow-up of 52 months (range 20–132 months). We observed a mean increase of 6.2 cm 3 (range 0.2–23.7 cm 3 ) per patient and side during the follow-up period. Bone surface-based registration was significantly more accurate than skin surface-based registration (mean 0.7 ± 0.4 mm and 1.9 ± 0.7 mm, p  
ISSN:0001-6268
0942-0940
0942-0940
DOI:10.1007/s00701-019-04015-y