Karsy Michael, Raheja Amol, Eli Ilyas, Guan Jian, Couldwell William T
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA; Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
World Neurosurg. 2017 Dec;108:748-755. doi: 10.1016/j.wneu.2017.09.090. Epub 2017 Sep 22.
The tuberculum sellae is a relatively common location for meningiomas. We assessed our experience with the use of transcranial resection, which, although criticized for its more invasive nature compared with endonasal approaches, may be the ideal approach in selected patients with tuberculum sellae meningiomas (TSMs).
We retrospectively reviewed the charts of patients with TSMs treated by frontotemporal or bifrontal open cranial resection. Clinical, radiographic, and surgical variables were analyzed.
Forty-nine patients with a TSM treated by frontotemporal or bifrontal open cranial resection were identified. The mean patient age was 53.2 ± 14.0 years, and the mean duration of follow-up was 42.3 ± 45.4 months. The mean tumor volume was 12.4 ± 18.0 cm. Optic canal invasion was seen in 46.9% of the patients, and 91.8% presented with visual deficits. Gross total resection (GTR) was achieved in 42 patients (85.7%), and near-total resection was performed in 7 patients (14.3%). Postoperatively, visual outcomes improved in 17 patients (34.7%), remained stable in 22 (44.9%), were intact in 6 (12.2%), and worsened in 1 (2.0%). Good outcome (Glasgow Outcome Scale [GOS] ≥4) was achieved by 46 of 49 patients (93%) at discharge and by 39 of 41 patients (95.1%) at 6 months. A total of 16 manageable and self-limiting complications occurred in 16 patients.
In most patients undergoing a frontotemporal approach, a GTR/Simpson grade I resection with manageable and self-limiting surgical complications, a good 6-month GOS in most patients, and improved to stable vision were seen at follow-up. Various treatment approaches can be considered for TSM resection, but the ability to decompress the optic canal and achieve a GTR makes the frontotemporal approach attractive in many cases.
鞍结节是脑膜瘤相对常见的发病部位。我们评估了经颅切除术的应用经验，尽管与经鼻入路相比，该术式因其侵袭性更强而受到批评，但对于某些鞍结节脑膜瘤（TSM）患者而言，它可能是理想的手术方式。
我们回顾性分析了接受额颞部或双额开颅切除术治疗的TSM患者的病历。对临床、影像学和手术变量进行了分析。
共确定49例接受额颞部或双额开颅切除术治疗的TSM患者。患者平均年龄为53.2±14.0岁，平均随访时间为42.3±45.4个月。平均肿瘤体积为12.4±18.0 cm³。46.9%的患者可见视神经管侵犯，91.8%的患者存在视力障碍。42例患者（85.7%）实现了肿瘤全切除（GTR），7例患者（14.3%）进行了近全切除。术后，17例患者（34.7%）视力改善，22例患者（44.9%）视力保持稳定，6例患者（12.2%）视力完好，1例患者（2.0%）视力恶化。49例患者中有46例（93%）出院时预后良好（格拉斯哥预后评分[GOS]≥4），41例患者中有39例（95.1%）在6个月时预后良好。16例患者出现了16例可处理的自限性并发症。
在大多数接受额颞部入路手术的患者中，随访时可见实现了GTR/辛普森一级切除，手术并发症可处理且为自限性，大多数患者6个月时GOS良好，视力改善至稳定。TSM切除可考虑多种治疗方法，但视神经管减压及实现GTR的能力使得额颞部入路在许多情况下颇具吸引力。
