Otani Naoki, Muroi Carl, Yano Hirohito, Khan Nadia, Pangalu Athina, Yonekawa Yasuhiro
Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland.
Br J Neurosurg. 2006 Jun;20(3):129-38. doi: 10.1080/02688690600776747.
A retrospective analysis of 32 patients with tuberculum sellae meningiomas who underwent surgery via a unilateral pterional approach was performed. A selective extradural anterior clinoidectomy (SEAC) technique was added in 20 patients. All patients had visual dysfunction preoperatively. Macroscopically complete removal with Simpson grade II was performed in 28 patients (87.5%). The postoperative visual function improved in 25 (78.1%), did not change in 3 (9.4%), and worsened in 4 patients (12.5%). The SEAC technique was effective, especially for removal of the tumour extending into the sellae/pituitary stalk (9 patients), the optic canal (4 patients) and hypothalamus (4 patients) with preservation of the visual and endocrinological function. These results were superior to those of surgery without SEAC technique. This technique is therefore recommended for complete resection of the tuberculum sellae meningiomas extending to the surrounding anatomical structures as the SEAC procedure reduces the risk of intraoperative optic nerve injury considerably.
对32例经单侧翼点入路行手术治疗的鞍结节脑膜瘤患者进行回顾性分析。20例患者采用了选择性硬膜外前床突切除术（SEAC）技术。所有患者术前均有视力障碍。28例患者（87.5%）实现了Simpson II级宏观全切。术后25例（78.1%）患者视力功能改善，3例（9.4%）患者视力功能未改变，4例（12.5%）患者视力功能恶化。SEAC技术有效，尤其对于切除延伸至鞍内/垂体柄（9例）、视神经管（4例）和下丘脑（4例）的肿瘤，同时能保留视力和内分泌功能。这些结果优于未采用SEAC技术的手术。因此，对于延伸至周围解剖结构的鞍结节脑膜瘤，推荐采用该技术进行全切，因为SEAC手术可显著降低术中视神经损伤的风险。
