Yang Alexander, Aref Mohammed, Youssef A Samy
Department of Neurosurgery, University of Colorado, Aurora, Colorado, United States.
J Neurol Surg B Skull Base. 2018 Feb;79(2):S219-S220. doi: 10.1055/s-0037-1618599. Epub 2018 Jan 16.
This is a case of an extensive tuberculum sella meningioma involving the circle of Willis down to the basilar artery that presented with bilateral visual loss worse on the right than left side. A one-piece right orbitopterional approach along the worse eye was used to gain access to the three cranial fossae. The orbitotomy facilitates access to the midline structures and contralateral base of the tumor with minimal brain retraction. Tumor resection is initiated by first identifying the tumor capsule, followed by piecemeal debulking via ultrasonic aspiration. Early decompression of the ipsilateral optic nerve was performed. Gross total resection of the tumor was achieved through multiple windows as follows: prechiasmatic, opticocarotid, and carotid oculomotor. Sharp dissection is performed around critical neurovascular structures to reduce strain and vascular injury. The circle of Willis including the small perforators was completely preserved. Postoperative examination at follow-up demonstrated improvement in vision less on the right side and resolution of postoperative partial third nerve palsy. The link to the video can be found at: https://youtu.be/XfEh8CjkvA0 .
这是一例广泛累及 Willis 环直至基底动脉的鞍结节脑膜瘤病例，患者出现双侧视力丧失，右侧比左侧更严重。采用沿患侧眼睛的一体式右眶翼点入路进入三个颅窝。眶部切开术便于以最小程度的脑牵拉进入中线结构和肿瘤的对侧基底。肿瘤切除首先通过识别肿瘤包膜开始，然后通过超声吸引进行分块切除。对同侧视神经进行早期减压。通过以下多个窗口实现了肿瘤的全切除：视交叉前、视神经颈动脉和颈动脉动眼神经。在关键神经血管结构周围进行锐性分离以减轻张力和血管损伤。包括小穿支在内的 Willis 环得以完全保留。随访时的术后检查显示右侧视力改善较少，术后部分动眼神经麻痹得到缓解。视频链接可在：https://youtu.be/XfEh8CjkvA0 找到。
