Enukleasi adalah pembedahan untuk mengangkat keseluruhan mata. Eviserasi adalah pembedahan untuk mengangkat isi bola mata,menyisakan otot dan bagian putih mata.

Eviserasi adalah operasi pengeluaran isi bola tanpa mengangkat sklera dan tanpa memotong otot-otot bola mata. Biasanya operasi ini dilakukan dengan teknik anestesi umum.

Enukleasi melibatkan pengangkatan bola mata dan sebagian nervus optikus anterior, dengan usaha untuk mempertahankan konjungtiva, kapsula Tenon, serta otot ekstraokular.

Eksenterasi orbita adalah pembedahan destruktif yang dilakukan pada situasi klinis yang genting sebagai upaya menyelamatkan jiwa. Eksenterasi terutama dilakukan pada kondisi keganasan orbita dan kadang-kadang untuk infeksi dan inflamasi orbita yang mengancam nyawa.

Eksenterasi orbita melibatkan pengangkatan jaringan lunak orbita termasuk bola mata. Prosedur tradisional mencakup pengangkatan bola mata, kelopak mata, konjungtiva, dan keseluruhan isi orbita termasuk area periorbita. Eksenterasi subtotal mencakup pengangkatan bola mata, konjungtiva, dan otot ekstraokular, tanpa dilakukan diseksi subperiosteal.

Meningiomas are brain tumors that develop in the meninges, the tissue that surrounds and protects the brain and spinal cord (figure 1). Although most meningiomas are not cancerous, these tumors can cause problems as they grow and press against important parts of the brain or spinal cord. The cause of meningiomas is not well understood, but may include both genetic (inherited) and environmental factors.

If the tumor grows large enough, vision problems may occur due to compression of the optic nerve.

Visual changes — Meningioma can cause partial or complete loss of vision, typically in one eye. There may also be other changes in vision, such as blind spots or blurred or double vision. Some people with meningioma do not notice these changes.

What difference does the location of the tumor make?

Convexity meningiomas

These grow on the surface of the brain, often toward the front. They may not produce symptoms until they reach a large size. Symptoms of a convexity meningioma are seizures, focal neurological deficits, or headaches.

Falx and Parasagittal meningiomas

The falx is a groove that runs between the two sides of the brain (front to back), and contains a large blood vessel (sagittal sinus). Parasagittal tumors lie near or close to the falx. Because of the danger of puncturing the blood vessels, removing a tumor in the falx or parasagittal region can be difficult. Large parasagittal meningiomas may result in bilateral leg weakness.

Olfactory groove meningiomas

Olfactory groove meningiomas grow along the nerves that run between the brain and the nose. These nerves allow you to smell, and so often tumors growing here cause loss of smell. If they grow large enough, olfactory groove meningiomas can also compress the nerves to the eyes, causing visual symptoms. Similarly, meningiomas growing on the optic nerve can cause visual problems, including loss of patches within your field of vision, or even blindness. They can grow to a large size prior to being diagnosed due to changes in the sense of smell and mental status changes being difficult to catch.

Sphenoid meningiomas

Sphenoid meningiomas lie behind the eyes. These tumors can cause visual problems, loss of sensation in the face, or facial numbness. Tumors in this location can sometimes involve the blood sources of the brain (e.g. cavernous sinus, or carotid arteries), making them difficult or impossible to completely remove.

Posterior fossa meningiomas

Posterior fossa tumors lie on the underside of the brain. These tumors can compress the cranial nerves causing facial symptoms or loss of hearing. Petroclival tumors can compress the trigeminal nerve, resulting in sharp pain in the face (trigeminal neuralgia) or spasms of the facial muscles. Tentorial meningiomas or those near the area where your spinal cord connects to your brain (foramen magnum) can cause headaches, or other signs of brain stem compression like trouble walking.

Intraventricular meningiomas

Intraventricular meningiomas are associated with the connected chambers of fluid that circulate throughout the central nervous system. They can block the flow of this fluid causing pressure to build up, which can produce headaches and dizziness.

Intraorbital meningiomas

Intraorbital meningiomas grow around the eye sockets of your skull and can cause pressure in the eyes to build up, giving a bulging appearance. They can also cause an increasing loss of vision.

Spinal meningiomas

Spinal meningiomas account for less than 10% of meningiomas. They tend to occur in women (with a female/ male ratio of 5:1), usually between the ages of 40 and 70. They are intradural (within or enclosed within the dura mater), extramedullary (outside or unrelated to any medulla) tumors occurring predominantly in the thoracic spine. They can cause back pain, or pain in the limbs from compression of the nerves where they run into the spinal cord.

How common is each location?

Falx or parasagittal 25%Convexity 20%Sphenoid wing 20%Olfactory groove 10%Supresellar 10%Posterior fossa (petrosal) 10%Intraventricular 2%Miscellaneous (e.g., optic nerve, clivius) 3%

Sphenoid Wing Meningioma

Sphenoid wing meningioma, which forms on the skull base behind the eyes. Approximately 20% of meningiomas are sphenoid wing.

The evidence that implicates gender-specific hormones in the pathogenesis of meningioma emanates from data showing increased growth of meningiomas during pregnancy and change in size during menses. Observational data have identified the menopause and oophorectomy as conferring protection against the risk of developing meningiomas, while adiposity is positively associated with the disease. These tumors are also positively associated with breast cancer, although they express a different gonadal steroid receptor repertoire. About 70% of meningiomas express progesterone receptors, while fewer than 31% express estrogen receptors. These observations suggest that progesterone influences tumor growth. A progesterone antagonist such as mifepristone therefore may inhibit tumor growth. The use of hormone replacement therapy in symptomatic postmenopausal women either with previously treated disease or with dormant tumors is discussed, but remains controversial.

 Ever use of estradiol-only therapy was associated with an increased risk of meningioma (standardized incidence ratio = 1.29, 95% confidence interval: 1.15, 1.44).