Ajlan Abdulrazag M, Choudhri Omar, Hwang Peter, Harsh Griffith
Department of Neurosurgery, Stanford University, Stanford, California, United States ; Department of Neurosurgery, King Saud University, Riyadh, Saudi Arabia.
Department of Neurosurgery, Stanford University, Stanford, California, United States.
J Neurol Surg B Skull Base. 2015 Feb;76(1):74-9. doi: 10.1055/s-0034-1390400. Epub 2014 Sep 29.
Introduction Although tuberculum sellae (TS) and diaphragma sellae (DS) meningiomas have different anatomical origins, they are frequently discussed as a single entity. Here we review the radiologic and intraoperative findings of TS and DS meningiomas and propose a radiologic classification. Methods We retrospectively reviewed 10 consecutive TS and DS meningiomas. Data regarding clinical presentation, preoperative imaging, and intraoperative findings were analyzed. Three sellar dimensions were measured on magnetic resonance imaging (MRI): the tuberculum-sellar floor interval (TSFI), the planum-tuberculum interval (PTI), and the total height. Results Three distinct anatomical patterns were recognized: exclusively tubercular meningiomas (type A) were accompanied by elongation of the TSFI and, more significantly, of the PTI; combined TS and DS meningiomas (type B) were associated with relative elongation of both the PTI and TSFI; and the sole exclusively DS meningioma (type C) was associated with elongation of neither PTI nor TSFI. Conclusion Suprasellar meningiomas can be classified as tubercular, combined, or diaphragmatic based on preoperative MRI. Exclusively tubercular meningiomas (type A) require only a supradiaphragmatic approach. Tumor involvement of the sellar diaphragm (type B or C) requires resection of the diaphragm and thus a combined infra- and supradiaphragmatic approach.
引言 虽然鞍结节（TS）和鞍隔（DS）脑膜瘤有不同的解剖学起源，但它们常被作为一个单一实体进行讨论。在此，我们回顾TS和DS脑膜瘤的影像学及术中发现，并提出一种影像学分类方法。方法 我们回顾性分析了连续10例TS和DS脑膜瘤。分析了临床表现、术前影像学及术中发现的数据。在磁共振成像（MRI）上测量三个鞍区维度：鞍结节 - 鞍底间距（TSFI）、蝶鞍平面 - 鞍结节间距（PTI）及总高度。结果 识别出三种不同的解剖学模式：单纯鞍结节脑膜瘤（A型）伴有TSFI延长，更显著的是PTI延长；鞍结节和鞍隔联合脑膜瘤（B型）与PTI和TSFI的相对延长有关；唯一的单纯鞍隔脑膜瘤（C型）与PTI和TSFI均无延长有关。结论 基于术前MRI，鞍上脑膜瘤可分为鞍结节型、联合型或鞍隔型。单纯鞍结节脑膜瘤（A型）仅需经鞍隔上入路。肿瘤累及鞍隔（B型或C型）需要切除鞍隔，因此需要联合经鞍隔上下入路。
