Work

Treatment of midline craniofacial meningiomas: what did we learn from the analysis of 125 observations? Part 2. Prognostic factors and treatment algorithms

Year: 2023

Type: article

Abstract: The second part of the research is devoted to the study of one of the most difficult groups of skull base tumors to treat — median meningiomas of the anterior parts of the skull base, spreading into the nasal cavity and paranasal sinuses, and into the orbit in some cases (median craniofacial meningiomas). Purpose of the study. Result analysis of a single-center study including patients with benign (WHO grade I/II) median craniofacial meningiomas who underwent surgical or combined treatment, as well as the development of recommendations for treatment tactics based on this analysis, identification of factors affecting early and long-term outcomes, complications, overall and progression-free survival. Material and methods.The data of 125 patients (89 women and 36 men) who underwent surgical treatment were analyzed. Follow-up data were available from 90. Of these, surgical treatment was performed in 53 patients, combined — in 37. Three groups were distinguished in the sample: meningiomas with predominantly intracranial growth (37 cases), with predominantly extracranial growth (47 cases), and with pronounced intracranial and extracranial spread (41 cases). An analysis was made of predictors of results and outcomes of treatment, overall and progression-free survival of patients in the entire sample and separately in three groups. Results. There were identified statistically significant prognostic factors. They were obtained from the results of treatment presented in Part I of this study and the obtained information about predictors, algorithms for the treatment of patients with meningiomas with predominantly intracranial growth, with predominantly extracranial growth, and with pronounced intracranial and extracranial spread were formulated. Algorithms include recommendations for planning the scope of the intervention, adjuvant radiation treatment, the choice of surgical approach and reconstruction of the skull base defect, as well as determining indications for decompression of the optic nerves. Conclusion. The following statements have been convincingly demonstrated: the advantage of curative resection over palliative surgery, the feasibility of adjuvant radiation treatment of non-radically removed meningiomas, the importance of total removal of meningiomas of the anterior cranial fossa together with the affected area of the skull base, high efficiency of access through the frontal sinus for radical removal of meningiomas and hermetic reconstruction of skull base defects, the absolute advantage endoscopic endonasal access over transfacial, the expediency of decompression of the optic nerves in the canals at the reversible stage of visual impairment.

Source: Russian Rhinology

DOI: 10.17116/rosrino2023310116