de Divitiis Enrico, Esposito Felice, Cappabianca Paolo, Cavallo Luigi M, de Divitiis Oreste
Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy.
Neurosurgery. 2008 Mar;62(3):556-63; discussion 556-63. doi: 10.1227/01.neu.0000317303.93460.24.
Tuberculum sellae meningiomas represent 5 to 10% of all intracranial meningiomas. Such lesions are classically removed through a variety of well-standardized transcranial approaches. The extended endonasal transsphenoidal route, under either microscopic or endoscopic visualization, has only recently been proposed as a viable surgical technique for the management of such tumors.
A total of 51 consecutive patients with tuberculum sellae meningiomas were treated at our institution during a 21-year period. Forty-four patients had transcranial surgery, and the last seven were treated via the extended endoscopic transsphenoidal approach. We also compared our data with those reported in the pertinent literature related to the surgical, ophthalmological, and endocrinological outcome.
The significant difference among the transcranial and transsphenoidal series, both in our experience and in the reviewed literature, did not allow us to draw statistically significant results but rather a reporting of the outcomes. In the transcranial group, 86.4% had a gross total removal of the lesion, whereas the percentage was 83.3% in the transsphenoidal group. Concerning the visual outcome, we experienced postoperative improvement in 61.4% of the transcranial patients and a worsening of 13.6%, whereas improvement was reported in 71.4% of the patients in the transsphenoidal group; in the last group, we did not observe any postoperative worsening. The main drawback of the transsphenoidal approach still remains the difficulty in reconstructing the cranial base dural and bone defects, which expose patients to a greater risk of postoperative cerebrospinal fluid leakage (28.6% in our series) and related complications.
When treating a patient with a diagnosis of tuberculum sellae meningioma, a neurosurgeon should know that, aside from the classical transcranial approach, the possibility of an extended transsphenoidal approach exists. Although it is still not a standardized procedure, in carefully selected cases (i.e., small midline lesions, without major vessel encasement, or parasellar extension) and in experienced hands, it could be considered a viable alternative, especially in overcoming the reconstruction-related problems.
鞍结节脑膜瘤占所有颅内脑膜瘤的5%至10%。此类病变传统上通过多种标准化的经颅入路进行切除。经鼻蝶扩大入路，无论是在显微镜还是内镜直视下，直到最近才被提出作为治疗此类肿瘤的一种可行的手术技术。
在21年期间，我们机构共连续治疗了51例鞍结节脑膜瘤患者。44例患者接受了经颅手术，最后7例通过经鼻蝶扩大内镜入路治疗。我们还将我们的数据与相关文献中报道的手术、眼科和内分泌学结果进行了比较。
在我们的经验以及所回顾的文献中，经颅和经蝶手术系列之间的显著差异使我们无法得出具有统计学意义的结果，而只能报告结果。在经颅组中，86.4%的患者实现了病变全切，而经蝶组的这一比例为83.3%。关于视力结果，我们发现经颅手术患者术后视力改善的比例为61.4%，视力恶化的比例为13.6%，而经蝶组患者中报告视力改善的比例为71.4%；在经蝶组中，我们未观察到任何术后视力恶化情况。经蝶入路的主要缺点仍然是重建颅底硬脑膜和骨缺损存在困难，这使患者面临更高的术后脑脊液漏风险（我们系列中的比例为28.6%）及相关并发症。
在治疗诊断为鞍结节脑膜瘤的患者时，神经外科医生应知晓，除了经典的经颅入路外，还存在经鼻蝶扩大入路的可能性。尽管它仍不是一种标准化手术，但在精心挑选的病例中（即中线小病变、无主要血管包绕或鞍旁扩展），并且由经验丰富的医生操作时，它可被视为一种可行的替代方法，尤其是在克服与重建相关的问题方面。
