Efficacy of Pterional Approach in Surgical Management of Meningioma En Plaque.

Background: One-third of brain malignancies are meningioma. Cushing established meningioma en plaque (MEP) as a flat, soft dura mater tumor. It invades bones, causing hyperostosis. The tumors are called MEP, or spheno-orbital meningiomas (SOM). SOM invades the sphenoid wing and can spread to the orbit, infratemporal fossa, and cavernous sinus, which makes surgery to be more difficult. Hyperostosis may compress the optic and other cranial nerves. Proptosis, eyesight impairment, and cosmetic abnormalities are also caused by hyperostosis. Full resection improves proptosis and visual issues. Thus, the surgical technique is critical. Objectives: This study aimed to investigate the outcome of ten patients treated by microsurgical resection through pterional approach. Patients and methods: This retrospective study included 10 cases of hyperostosis and proptosis-characterized plaque meningioma. We assessed the surgical procedure, technique, resection extent, and postoperative outcomes. Results: All participants were women, except for one was male. Participants had a mean age of 45.4 years. All 10 patients had proptosis as their main symptom. Two had headaches and retro-orbital pain, while three claimed vision impairment. Pterional was utilized in all instances. Total tumor resection occurred 5 times, subtotal 3 times, and partial 2 times. Seven patients had proptosis improvement, two had partial improvement, and one had no change after three months. Cerebrospinal fluid leak, infection, hydrocephalus, and visual impairment occurred separately after surgery. Conclusions: To achieve effective surgical resection and clinical improvement of proptosis, the lateral and superior orbital walls must be drilled, and any intra-orbital soft tissue components were removed. However, complications such as hyperostosis development on the infra-temporal fossa or medial orbital wall, tumor invasion of the cavernous sinus, or tumor attachment to orbital muscles preclude complete excision. [ABSTRACT FROM AUTHOR]

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