Mortazavi Martin M, Brito da Silva Harley, Ferreira Manuel, Barber Jason K, Pridgeon James S, Sekhar Laligam N
Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA.
Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA; Department of Radiology, University of Washington, Harborview Medical Center, Seattle, Washington, USA.
World Neurosurg. 2016 Feb;86:270-86. doi: 10.1016/j.wneu.2015.09.043. Epub 2015 Sep 25.
The resection of planum sphenoidale and tuberculum sellae meningiomas is challenging. A universally accepted classification system predicting surgical risk and outcome is still lacking.
We report a modern surgical technique specific for planum sphenoidale and tuberculum sellae meningiomas with associated outcome. A new classification system that can guide the surgical approach and may predict surgical risk is proposed.
We conducted a retrospective review of the patients who between 2005 and March 2015 underwent a craniotomy or endoscopic surgery for the resection of meningiomas involving the suprasellar region. Operative nuances of a modified frontotemporal craniotomy and orbital osteotomy technique for meningioma removal and reconstruction are described.
Twenty-seven patients were found to have tumors arising mainly from the planum sphenoidale or the tuberculum sellae; 25 underwent frontotemporal craniotomy and tumor removal with orbital osteotomy and bilateral optic canal decompression, and 2 patients underwent endonasal transphenoidal resection. The most common presenting symptom was visual disturbance (77%). Vision improved in 90% of those who presented with visual decline, and there was no permanent visual deterioration. Cerebrospinal fluid leak occurred in one of the 25 cranial cases (4%) and in 1 of 2 transphenoidal cases (50%), and in both cases it resolved with treatment. There was no surgical mortality.
An orbitotomy and early decompression of the involved optic canal are important for achieving gross total resection, maximizing visual improvement, and avoiding recurrence. The visual outcomes were excellent. A new classification system that can allow the comparison of different series and approaches and indicate cases that are more suitable for an endoscopic transsphenoidal approach is presented.
蝶骨平台和鞍结节脑膜瘤的切除具有挑战性。目前仍缺乏一个被普遍接受的预测手术风险和结果的分类系统。
我们报告一种针对蝶骨平台和鞍结节脑膜瘤的现代手术技术及其相关结果。提出一种可指导手术入路并可能预测手术风险的新分类系统。
我们对2005年至2015年3月间因切除累及鞍上区域的脑膜瘤而接受开颅手术或内镜手术的患者进行了回顾性研究。描述了一种改良额颞开颅和眶骨切开技术用于脑膜瘤切除及重建的手术细节。
27例患者被发现肿瘤主要起源于蝶骨平台或鞍结节；25例行额颞开颅、肿瘤切除、眶骨切开及双侧视神经管减压，2例行鼻内镜经蝶窦切除术。最常见的首发症状是视力障碍（77%）。视力下降患者中90%视力得到改善，且无永久性视力恶化。25例开颅手术中有1例（4%）发生脑脊液漏，2例经蝶窦手术中有1例（50%）发生脑脊液漏，两例均经治疗后愈合。无手术死亡病例。
眼眶切开术和受累视神经管的早期减压对于实现肿瘤全切、最大限度改善视力及避免复发至关重要。视力预后良好。提出一种新的分类系统，可用于比较不同系列和手术入路，并指出更适合鼻内镜经蝶窦入路的病例。
