Kitano Masahiko, Taneda Mamoru, Nakao Yuzo
Department of Neurosurgery, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan.
J Neurosurg. 2007 Aug;107(2):337-46. doi: 10.3171/JNS-07/08/0337.
Recently, extended transsphenoidal surgery (ETSS) has become an alternative to transcranial surgery (TCS) for suprasellar meningiomas, although the relative benefits of ETSS have yet to be established. To evaluate the effectiveness of ETSS, the authors analyzed surgical outcomes of TCS and ETSS.
During a 12-year period, 28 patients with meningiomas arising from the tuberculum sellae underwent tumor removal at Kinki University Hospital. The first 12 patients underwent TCS, and the remaining 16 underwent ETSS. In the TCS group, the optic canal on the approach side was unroofed in all cases. In the ETSS group bilateral optic canals were opened, and the dural and bone defects of the skull base were repaired using abdominal fascia and hydroxyapatite cement. In half of the cases, lumbar drainage of cerebrospinal fluid (CSF) was also performed.
In a retrospective analysis of this consecutive series of patients, improvement in visual acuity and intraoperative blood loss were significantly better in the ETSS group (p = 0.010 and p = 0.011, respectively), whereas improvement in visual field defects, operative times, and the tumor removal rate were not significantly different between the two groups. Nonvisual surgical complications such as CSF leakage (one patient) and infarction of a perforating artery (three patients) were observed in the TCS group. In the ETSS group, CSF leakage (two patients), anosmia (two patients), and infarction of a perforating artery (two patients) were observed.
Given the encouraging results in improvement in visual acuity, ETSS may be acceptable for the treatment of tuberculum sellae meningiomas.
最近，扩大经蝶窦手术（ETSS）已成为鞍上脑膜瘤经颅手术（TCS）的一种替代方法，尽管ETSS的相对优势尚未确立。为评估ETSS的有效性，作者分析了TCS和ETSS的手术结果。
在12年期间，28例起源于鞍结节的脑膜瘤患者在近畿大学医院接受了肿瘤切除手术。前12例患者接受了TCS，其余16例接受了ETSS。在TCS组中，所有病例均在手术入路侧打开视神经管。在ETSS组中，双侧视神经管均被打开，颅底的硬膜和骨缺损用腹直肌筋膜和羟基磷灰石水泥修复。在一半的病例中，还进行了脑脊液（CSF）腰大池引流。
在对这一系列连续患者的回顾性分析中，ETSS组的视力改善和术中失血情况明显更好（分别为p = 0.010和p = 0.011），而两组之间视野缺损的改善、手术时间和肿瘤切除率没有显著差异。TCS组观察到非视觉手术并发症，如脑脊液漏（1例患者）和穿支动脉梗死（3例患者）。在ETSS组中，观察到脑脊液漏（2例患者）、嗅觉丧失（2例患者）和穿支动脉梗死（2例患者）。
鉴于视力改善方面的令人鼓舞的结果，ETSS可能是治疗鞍结节脑膜瘤的可接受方法。
