OBJECTIVE The objective of this study was to evaluate the effect of reconstruction and orbital volume on the reduction of proptosis in patients undergoing resection for spheno-orbital meningiomas. Additionally, potential predictors of optimal proptosis reduction after surgery were evaluated. METHODS Patients with spheno-orbital meningiomas who underwent resection at the authors' institution between 2005 and 2020 were evaluated retrospectively. The exophthalmos index (EI) was measured on pre- and postoperative imaging to quantify proptosis and calculate the primary outcome measure of proptosis reduction. Patients were excluded if they had no preoperative proptosis (i.e., EI < 1.1), prior resection, or insufficient imaging available for analysis. Clinical and surgical characteristics were collected, including sex, extent of resection, WHO grade, and rigid orbital reconstruction, and assessed as predictors of greater proptosis reduction. Additionally, orbital volumes of the affected and contralateral orbits were measured to correlate postoperative orbital volumes with proptosis reduction. RESULTS Thirty-three patients, with a mean age of 53 years, met inclusion criteria. The majority of the patients were female (23, 69.7%), and most tumors were classified as WHO grade 1 (29, 87.9%). Six patients (18.2%) underwent rigid orbital reconstruction. The mean EI across all patients decreased from 1.36 ± 0.18 to 1.19 ± 0.15 (p < 0.001). Patients who underwent reconstruction had on average a 76.4% greater reduction in the EI (p = 0.036) and a 9.1 times higher odds of achieving a normal EI (< 1.1) compared with those who did not receive reconstruction (OR 9.1, p = 0.025). Additionally, patients without residual hyperostotic bone compressing the orbit had a 2.16 times greater reduction in EI (p = 0.039). A linear relationship between orbital volume ratios (affected/unaffected orbit) and proptosis reduction was observed (p = 0.029, r = 0.529), including at ratios > 1.0. This suggests that greater orbital volumes postoperatively correlated with greater reductions in proptosis. CONCLUSIONS Three factors were identified that optimize proptosis correction. First, all abnormal bone compressing the orbital contents must be removed completely. Second, rigid orbital reconstruction leads to improved proptosis correction, possibly by preventing frontal lobe and dural reconstruction from descending onto the compressed orbit. Third, aiming for an orbital volume slightly larger than the contralateral normal side leads to improved proptosis correction.

中文翻译：

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蝶眼眶脑膜瘤切除术后眼球突出矫正中的眼眶重建和体积。

目的 本研究的目的是评估重建和眼眶容积对接受蝶眼眶脑膜瘤切除术的患者突眼减少的影响。此外，还评估了手术后最佳眼球突出减少的潜在预测因素。方法 对 2005 年至 2020 年间在作者所在机构接受切除术的蝶眶脑膜瘤患者进行回顾性评估。在术前和术后成像中测量突眼指数（EI），以量化眼球突出并计算眼球突出减少的主要结果指标。如果患者没有术前突眼（即 EI < 1.1）、既往切除术或可供分析的影像学不足，则被排除在外。收集临床和手术特征，包括性别、切除范围、WHO 分级和刚性眼眶重建，并评估作为更大程度突眼减少的预测因素。此外，还测量了受影响和对侧眼眶的眼眶体积，以将术后眼眶体积与眼球突出减少相关联。结果 33 名患者符合纳入标准，平均年龄 53 岁。大多数患者为女性（23 例，69.7%），大多数肿瘤被分类为 WHO 1 级（29 例，87.9%）。六名患者（18.2%）接受了刚性眼眶重建。所有患者的平均 EI 从 1.36 ± 0.18 降至 1.19 ± 0.15 (p < 0.001)。与未接受重建的患者相比，接受重建的患者的 EI 平均降低了 76.4%（p = 0.036），并且达到正常 EI（< 1.1）的几率高出 9.1 倍（OR 9.1，p = 0.025） ）。此外，没有残余骨质增生压迫眼眶的患者 EI 降低了 2.16 倍（p = 0.039）。观察到眼眶体积比（受影响/未受影响的眼眶）与眼球突出减少之间存在线性关系（p = 0.029，r = 0.529），包括比率 > 1.0 时。这表明术后更大的眼眶体积与眼球突出的更大程度减少相关。结论 确定了优化眼球突出矫正的三个因素。首先，必须完全去除所有压迫眼眶内容物的异常骨骼。其次，刚性眼眶重建可能通过防止额叶和硬脑膜重建下降到压缩眼眶来改善眼球突出矫正。第三，眼眶体积略大于对侧正常侧可改善突眼矫正。