Sade Burak, Lee Joung H
Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Surg Neurol. 2009 Aug;72(2):118-23; discussion 123. doi: 10.1016/j.surneu.2008.08.007. Epub 2009 Jan 14.
Current literature on TSMs underemphasizes the significance of OCI by the tumor. In this study, we aimed to document the incidence of OCI, its management using a SBT, and its significance with relation to the visual outcome.
Thirty-one patients with TSM were retrospectively analyzed. In 28 patients, SBT consisting of extradural anterior clinoidectomy with falciform ligament and optic nerve sheath opening was performed. Pre- and postoperative visual status was analyzed with respect to OCI.
The incidences of OCI and preoperative visual deficit (VD) were 77.4% and 83.8%, respectively. With regard to preoperative visual status, OCI incidence was 84.6% in 26 patients with VD compared to 40% in 5 patients without (P = .016). Among the 23 patients with VD and detailed postoperative neuroopthalmologic evaluation, 78.3% had visual improvement; and in 21.7%, vision was unchanged on the operated side. In one patient (3.2% in the whole series), vision deteriorated on the side contralateral to the side of surgery. In the presence of OCI in 20 patients, vision improved in 80% and remained unchanged in 20%, whereas 1 of the 3 patients without OCI improved and the other 2 remained unchanged. Simpson grade I or II resection was achieved in 83.8%.
Optic canal involvement is very common in TSM (77.4%), and it correlates well with preoperative visual status. With the use of SBT, without which the tumor in the optic canal could not have been removed completely and safely, visual improvement of 78.3% and stability of 21.7% were achieved on the operated side.
目前关于蝶骨嵴脑膜瘤（TSM）的文献未充分强调肿瘤对视神经鞘间隙（OCI）侵犯的重要性。在本研究中，我们旨在记录OCI的发生率、使用视神经鞘减压术（SBT）对其进行的处理，以及它与视力预后的关系。
对31例TSM患者进行回顾性分析。其中28例患者接受了由硬膜外前床突切除术、镰状韧带及视神经鞘切开术组成的SBT。分析术前和术后与OCI相关的视力状况。
OCI的发生率和术前视力缺损（VD）分别为77.4%和83.8%。就术前视力状况而言，26例有VD的患者中OCI发生率为84.6%，而5例无VD的患者中为40%（P = 0.016）。在23例有VD且术后进行了详细神经眼科评估的患者中，78.3%的患者视力得到改善；21.7%的患者患侧视力无变化。1例患者（占整个系列的3.2%）手术对侧视力恶化。20例存在OCI的患者中，80%视力改善，20%不变，而3例无OCI的患者中1例改善，另外2例不变。83.8%的患者达到了辛普森一级或二级切除。
视神经管受累在TSM中非常常见（77.4%），且与术前视力状况密切相关。通过使用SBT，如果不采用该方法视神经管内的肿瘤无法完全安全切除，患侧视力改善率达78.3%，稳定率达21.7%。
