Bitter Andrej D, Stavrinou Lampis C, Ntoulias Georgios, Petridis Athanasios K, Dukagjin Morina, Scholz Martin, Hassler Werner
Department of Neurosurgery, Klinikum Duisburg, Duisburg NRW, Germany.
Department of Neurosurgery, Evangelisches Krankenhaus Bielefeld, Bielefeld NRW, Germany.
J Neurol Surg B Skull Base. 2013 Apr;74(2):97-102. doi: 10.1055/s-0033-1333618. Epub 2013 Jan 22.
Background Olfactory groove meningiomas remain surgically challenging. The common microsurgical approaches suffer from late exposure of the neurovascular structures. Conversely, the pterional approach has the advantage of early dissection of the posterior neurovascular complex. Methods We reviewed the records of patients treated for olfactory groove meningioma in our department between 1991 and 2010. A total of 61 patients underwent removal of olfactory groove meningiomas via the pterional approach. These included 58 primary and 3 recurrent tumors. Mean overall follow-up time was 122 months. Results Early exposure and dissection of the internal carotid artery, middle cerebral artery, anterior cerebral artery, and optic nerve was feasible in all cases. Complete tumor removal was achieved in 60 patients. Morbidity and mortality rates were 26% and 1.6% respectively. Postoperative complications included epileptic seizures (five patients) and cerebrospinal fluid (CSF) leak (two patients). During follow-up, we recorded three tumor recurrences. Conclusions The pterional approach appears to be an excellent solution for the treatment of olfactory groove meningiomas. Its foremost advantage is early visualization of the posterior neurovascular complex. Moreover, it allows frontal sinus preservation and timely tumor devascularization and avoids excessive brain retraction. The pterional view is familiar to most neurosurgeons and therefore the transition to this technique is fairly straightforward.
背景 嗅沟脑膜瘤的手术治疗仍具有挑战性。常见的显微手术入路存在神经血管结构暴露较晚的问题。相反，翼点入路具有早期解剖后神经血管复合体的优势。方法 我们回顾了1991年至2010年间在我科接受嗅沟脑膜瘤治疗的患者记录。共有61例患者通过翼点入路切除嗅沟脑膜瘤。其中包括58例原发性肿瘤和3例复发性肿瘤。平均总随访时间为122个月。结果 在所有病例中，早期暴露和解剖颈内动脉、大脑中动脉、大脑前动脉和视神经都是可行的。60例患者实现了肿瘤全切。发病率和死亡率分别为26%和1.6%。术后并发症包括癫痫发作（5例患者）和脑脊液漏（2例患者）。在随访期间，我们记录到3例肿瘤复发。结论 翼点入路似乎是治疗嗅沟脑膜瘤的极佳方法。其最主要的优势是能早期显露后神经血管复合体。此外，它允许保留额窦，能及时使肿瘤去血管化，并避免过度牵拉脑组织。大多数神经外科医生对翼点视角都很熟悉，因此向该技术的转变相当简单。
