Schick U, Hassler W
Clinic of Neurological Surgery, Wedau Kliniken, Zu den Rehwiesen 9, 47055 Duisburg, Germany.
J Neurol Neurosurg Psychiatry. 2005 Jul;76(7):977-83. doi: 10.1136/jnnp.2004.039974.
To present a large series of surgically treated tuberculum sellae meningiomas with particular regard to involvement of the optic canal and visual outcome.
A retrospective analysis was done on 53 patients (40 female) with meningiomas originating from the tuberculum sellae who underwent surgery between 1991 and 2002. The standard surgical approach consisted of pterional craniotomy. Sixteen meningiomas extended posteriorly onto the diaphragma sella, 29 anteriorly to the planum sphenoidale, and 19 to the anterior clinoid process. Thirty seven tumours involved the optic canal, three bilaterally. Follow up ranged from 6 to 108 months (mean 29.9 months).
Total macroscopic resection was achieved in 48 patients. Median tumour size was 2.6 cm. Postoperatively, visual acuity improved in 20 patients and deteriorated in seven. Preoperative and postoperative visual acuity worsened with increasing duration of preoperative symptoms and with increasing age. Extension into the intraconal space was a negative predictor. However, tumour size did not influence visual acuity. Recurrence occurred in two cases (21 and 69 months postoperatively). Two patients died from causes unrelated to the tumour.
In the majority of patients with tuberculum sellae meningiomas, total resection may be achieved through a pterional approach with minimal complications.
呈现一系列经手术治疗的鞍结节脑膜瘤，特别关注视神经管受累情况及视觉预后。
对1991年至2002年间接受手术的53例起源于鞍结节的脑膜瘤患者（40例女性）进行回顾性分析。标准手术入路为翼点开颅术。16例脑膜瘤向后延伸至鞍膈，29例向前延伸至蝶骨平台，19例延伸至前床突。37例肿瘤累及视神经管，3例双侧受累。随访时间为6至108个月（平均29.9个月）。
48例患者实现了肿瘤全切。肿瘤中位数大小为2.6厘米。术后，20例患者视力改善，7例患者视力恶化。术前和术后视力随着术前症状持续时间的延长和年龄的增加而恶化。延伸至眶内间隙是视力预后不良的预测因素。然而，肿瘤大小并不影响视力。2例患者复发（分别在术后21个月和69个月）。2例患者死于与肿瘤无关的原因。
对于大多数鞍结节脑膜瘤患者，通过翼点入路可实现肿瘤全切，且并发症最少。
