Dogan Ihsan, Ucer Melih, Başkaya Mustafa Kemal
Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States.
J Neurol Surg B Skull Base. 2018 Feb;79(2):S218. doi: 10.1055/s-0037-1620254. Epub 2018 Jan 16.
Microsurgical treatment of suprasellar tumors, in particular tuberculum sellae meningiomas, poses significant challenge. These tumors are surrounded by vital neurovascular structures, such as optic apparatus, pituitary stalk, internal carotid artery and its branches, and anterior cerebral arteries. In large and complex cases, early identification and decompression of these structures may facilitate safer dissection and resection. Therefore, extradural anterior clinoidectomy with optic unroofing facilitates the internal carotid artery exposure and optic nerve decompression. In this video, we describe a 37-year-old female patient who presented with new onset of severe headaches. On visual examination, she was found to have bitemporal visual defects. MRI scan of the head showed a large, approximately 3 cm suprasellar tumor consistent with tuberculum sellae meningioma. She underwent surgical resection via pterional craniotomy with extradural anterior clinoidectomy and optic unroofing. Microsurgical gross total resection was achieved and histopathology was WHO grade II meningioma. She had an uneventful postoperative course and visual field examination improved significantly. In this video, surgical technique in performing extradural anterior clinoidectomy and optic unroofing and steps of microsurgical resection are demonstrated. The link to the video can be found at: https://youtu.be/oPZ8NTyvxJc .
鞍上肿瘤的显微外科治疗，尤其是鞍结节脑膜瘤，极具挑战性。这些肿瘤被重要的神经血管结构所环绕，如视器、垂体柄、颈内动脉及其分支以及大脑前动脉。在大型复杂病例中，早期识别并减压这些结构有助于更安全地进行分离和切除。因此，硬膜外前床突切除术联合视神经管开放术有助于暴露颈内动脉并对视神经进行减压。在本视频中，我们描述了一名37岁女性患者，她出现新发的严重头痛。视力检查发现她有双颞侧视野缺损。头部MRI扫描显示一个约3厘米的大型鞍上肿瘤，符合鞍结节脑膜瘤。她接受了经翼点开颅术联合硬膜外前床突切除术及视神经管开放术的手术切除。实现了显微外科全切除，组织病理学检查为世界卫生组织二级脑膜瘤。她术后恢复顺利，视野检查有显著改善。在本视频中，展示了进行硬膜外前床突切除术及视神经管开放术的手术技巧以及显微外科切除步骤。视频链接可在：https://youtu.be/oPZ8NTyvxJc 找到。
