Shetty Sathwik Raviraj, Ruiz-Treviño Armando S, Omay Sacit Bulent, Almeida Joao Paulo, Liang Buqing, Chen Yu-Ning, Singh Harminder, Schwartz Theodore H
Department of Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
Department of Neurosurgery, Stanford Hospital, Stanford, CA, USA.
Acta Neurochir (Wien). 2017 Oct;159(10):1875-1885. doi: 10.1007/s00701-017-3303-0. Epub 2017 Aug 22.
To review current management strategies for olfactory groove meningioma (OGM)s and the recent literature comparing endoscopic endonasal (EEA) with traditional transcranial (TCA) approaches.
A PubMed search of the recent literature (2011-2016) was performed to examine outcomes following EEA and TCA for OGM. The extent of resection, visual outcome, postoperative complications and recurrence rates were analyzed using percentages and proportions, the Fischer exact test and the Student's t-test using Graphpad PRISM 7.0Aa (San Diego, CA) software.
There were 444 patients in the TCA group with a mean diameter of 4.61 (±1.17) cm and 101 patients in the EEA group with a mean diameter of 3.55 (± 0.58) cm (p = 0.0589). GTR was achieved in 90.9% (404/444) in the TCA group and 70.2% (71/101) in the EEA group (p < 0.0001). Of the patients with preoperative visual disturbances, 80.7% (21/26) of patients in the EEA cohort had an improvement in vision compared to 12.83%(29/226) in the TCA group (p < 0.0001). Olfaction was lost in 61% of TCA and in 100% of EEA patients. CSF leaks and meningitis occurred in 25.7% and 4.95% of EEA patients and 6.3% and 1.12% of TCA patients, respectively (p < 0.0001; p = 0.023).
Our updated literature review demonstrates that despite more experience with endoscopic resection and skull base reconstruction, the literature still supports TCA over EEA with respect to the extent of resection and complications. EEA may be an option in selected cases where visual improvement is the main goal of surgery and postoperative anosmia is acceptable to the patient or in medium-sized tumors with existing preoperative anosmia. Nevertheless, based on our results, it seems more prudent at this time to use TCA for the majority of OGMs.
回顾目前嗅沟脑膜瘤（OGM）的治疗策略，以及近期比较鼻内镜下经鼻入路（EEA）与传统经颅入路（TCA）的文献。
对近期文献（2011 - 2016年）进行PubMed检索，以研究EEA和TCA治疗OGM后的疗效。使用百分比和比例、Fisher精确检验以及使用Graphpad PRISM 7.0Aa（加利福尼亚州圣地亚哥）软件进行的Student t检验，分析切除范围、视力结果、术后并发症和复发率。
TCA组有444例患者，平均直径为4.61（±1.17）cm；EEA组有101例患者，平均直径为3.55（±0.58）cm（p = 0.0589）。TCA组90.9%（404/444）实现了肿瘤全切除（GTR），EEA组为70.2%（71/101）（p < 0.0001）。术前有视力障碍的患者中，EEA队列中80.7%（21/26）的患者视力有所改善，而TCA组为12.83%（29/226）（p < 0.0001）。TCA组61%的患者嗅觉丧失，EEA组100%的患者嗅觉丧失。EEA组脑脊液漏和脑膜炎的发生率分别为25.7%和4.95%，TCA组分别为6.3%和1.12%（p < 0.0001；p = 0.023）。
我们更新的文献综述表明，尽管鼻内镜切除和颅底重建经验更多，但在切除范围和并发症方面，文献仍支持TCA优于EEA。在手术的主要目标是改善视力且患者可接受术后嗅觉丧失的特定病例中，或在术前已有嗅觉丧失的中型肿瘤中，EEA可能是一种选择。然而，基于我们的结果，目前对于大多数OGM使用TCA似乎更为谨慎。
