Shimano H, Nagasawa S, Kawabata S, Ogawa R, Ohta T
Department of Neurosurgery, Osaka Medical College.
Neurol Med Chir (Tokyo). 2000 Sep;40(9):447-51; discussion 451-2. doi: 10.2176/nmc.40.447.
Neuroimaging of the extension of meningioma into the optic canal was evaluated for planning the surgical strategy. Intracanalicular extension and localization were retrospectively analyzed in 13 patients with frontal base meningioma near the optic canal, based on the findings of visual field defects, magnetic resonance (MR) imaging, and surgical observations. MR imaging confirmed intracanalicular localization in one of three patients with tumors extending into the optic canals, and indicated the tumor in the others. The visual field defect did not precisely correspond to the tumor localization. Unroofing of the optic canal was performed in four patients and no adverse effects were observed. The interhemispheric approach was employed for tumors localized medially in the canal, and the pterional approach for tumors localized laterally. MR imaging is useful to evaluate the intracanalicular extension, but aggressive confirmation during surgery is essential. Tailored unroofing of the optic canal and removal of the intracanalicular tumor can be performed with few adverse effects and results in good tumor control.
为制定手术策略，对脑膜瘤向视神经管延伸的神经影像学表现进行了评估。基于视野缺损、磁共振（MR）成像及手术观察结果，对13例视神经管附近额底脑膜瘤患者的管内延伸及定位情况进行了回顾性分析。MR成像证实，在3例肿瘤延伸至视神经管的患者中，有1例肿瘤位于管内，其他患者的肿瘤位置也通过MR成像得以明确。视野缺损与肿瘤定位并不完全相符。4例患者实施了视神经管减压术，未观察到不良反应。对于位于管内侧的肿瘤采用经纵裂入路，位于外侧的肿瘤采用翼点入路。MR成像有助于评估管内延伸情况，但手术中积极确认至关重要。对视神经管进行个体化减压并切除管内肿瘤，不良反应少，肿瘤控制效果良好。
