Tag: skull base tumor

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Resectability of spheno-orbital meningiomas: surgical outcome in 93 cases and a proposed clinically relevant anatomical classification

J Neurosurg 144:336–345, 2026

This clinical study evaluates surgical outcomes for 93 patients with spheno-orbital meningiomas (SOMs) treated over two decades, proposing a four-grade anatomical classification based on orbital involvement. The paper reports presentation patterns, operative techniques, extent of resection, proptosis quantification with an exophthalmos index, and postoperative visual and surgical morbidity rates.

Using retrospective imaging and clinical data, the authors validate the grading system’s predictive value for resectability, proptosis improvement, and visual risk, showing higher gross-total resection rates in lower-grade tumors and substantial vision stabilization or improvement across grades. The work offers practical guidance for surgical planning and patient counseling in complex skull-base and orbital tumor management.

Anatomical Grading System: SOMs are classified into four grades based on orbital involvement: grade 1 (orbital hyperostosis), grade 2 (periorbital involvement), grade 3a/b (intraorbital involvement without/with rectus muscle invasion), and grade 4 (involvement of the orbital apex or optic nerve).

Surgical Resectability: Gross-total resection (GTR) is most achievable in grade 1 (88.5%) and decreases with higher grades (grade 2: 50.0%, grade 3: 16.7%, grade 4: 24.1%), primarily limited by critical neurovascular structures and functional vision considerations.

Presenting Symptoms: Proptosis (74.2%) and visual decline (57.0%) are the most common symptoms, with higher-grade tumors more likely to present with proptosis, vision loss, and cranial neuropathies.

Visual Outcomes: Surgery led to stable or improved vision in nearly 95% of patients across all grades, with no significant difference in visual morbidity between low- and high-grade tumors.

Proptosis Improvement: Correction of proptosis was most significant in grades 2 and 4, with overall exophthalmos index (EI) significantly decreasing after surgery; clinically significant enophthalmos was rare.

Surgical Morbidity: Overall morbidity increased with higher tumor grade but was not statistically significant; new ophthalmological cranial nerve neuropathies occurred in 11.8% of patients.

Surgical Approach: Aggressive removal of tumor and hyperostotic bone, with selective intraorbital dissection, optimizes functional outcomes and proptosis reduction; rigid orbital reconstruction is generally not required.

Clinical Utility: The grading system aids in predicting surgical risks, visual outcomes, and in guiding patient counseling and surgical planning for SOMs.

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Interactive presurgical simulation applying 3D techniques

Presurgical simulation 3Dimaging

J Neurosurg 119:94–105, 2013

In this paper, the authors’ goal was to report their novel presurgical simulation method applying interactive virtual simulation (IVS) using 3D computer graphics (CG) data and microscopic observation of color-printed plaster models based on these CG data in surgery for skull base and deep tumors.

Methods. For 25 operations in 23 patients with skull base or deep intracranial tumors (meningiomas, schwannomas, epidermoid tumors, chordomas, and others), the authors carried out presurgical simulation based on 3D CG data created by image analysis for radiological data. Interactive virtual simulation was performed by modifying the 3D CG data to imitate various surgical procedures, such as bone drilling, brain retraction, and tumor removal, with manipulation of a haptic device. The authors also produced color-printed plaster models of modified 3D CG data by a selective laser sintering method and observed them under the operative microscope.

Results. In all patients, IVS provided detailed and realistic surgical perspectives of sufficient quality, thereby allowing surgeons to determine an appropriate and feasible surgical approach. Surgeons agreed that in 44% of the 25 operations IVS showed high utility (as indicated by a rating of “prominent”) in comprehending 3D microsurgical anatomies for which reconstruction using only 2D images was complicated. Microscopic observation of color-printed plaster models in 12 patients provided further utility in confirming realistic surgical anatomies.

Conclusions. The authors’ presurgical simulation method applying advanced 3D imaging and modeling techniques provided a realistic environment for practicing microsurgical procedures virtually and enabled the authors to ascertain complex microsurgical anatomy, to determine the optimal surgical strategies, and also to efficiently educate neurosurgical trainees, especially during surgery for skull base and deep tumors.

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Interactive presurgical simulation applying 3D techniques

3D CG data and the color-printed plaster model for a left tentorial meningioma

J Neurosurg 119:94–105, 2013

In this paper, the authors’ goal was to report their novel presurgical simulation method applying interactive virtual simulation (IVS) using 3D computer graphics (CG) data and microscopic observation of color-printed plaster models based on these CG data in surgery for skull base and deep tumors.

Methods. For 25 operations in 23 patients with skull base or deep intracranial tumors (meningiomas, schwannomas, epidermoid tumors, chordomas, and others), the authors carried out presurgical simulation based on 3D CG data created by image analysis for radiological data. Interactive virtual simulation was performed by modifying the 3D CG data to imitate various surgical procedures, such as bone drilling, brain retraction, and tumor removal, with manipulation of a haptic device. The authors also produced color-printed plaster models of modified 3D CG data by a selective laser sintering method and observed them under the operative microscope.

Results. In all patients, IVS provided detailed and realistic surgical perspectives of sufficient quality, thereby allowing surgeons to determine an appropriate and feasible surgical approach. Surgeons agreed that in 44% of the 25 operations IVS showed high utility (as indicated by a rating of “prominent”) in comprehending 3D microsurgical anatomies for which reconstruction using only 2D images was complicated. Microscopic observation of color-printed plaster models in 12 patients provided further utility in confirming realistic surgical anatomies.

Conclusions. The authors’ presurgical simulation method applying advanced 3D imaging and modeling techniques provided a realistic environment for practicing microsurgical procedures virtually and enabled the authors to ascertain complex microsurgical anatomy, to determine the optimal surgical strategies, and also to efficiently educate neurosurgical trainees, especially during surgery for skull base and deep tumors.

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