Engelhardt Julien, Namaki Houman, Mollier Olivier, Monteil Pascal, Penchet Guillaume, Cuny Emmanuel, Loiseau Hugues
Department of Neurosurgery, CHU de Bordeaux, Bordeaux Cedex, France.
Department of Neurosurgery, CHG de Perpignan, Perpignan, France.
World Neurosurg. 2018 Aug;116:e1066-e1074. doi: 10.1016/j.wneu.2018.05.166. Epub 2018 Jun 1.
One of the most challenging aspects of the surgical treatment of tuberculum sellae meningioma is to control the involvement of the inferomedial side of the optic nerve, which is not directly visualized by an ipsilateral approach and thus requires optic nerve mobilization.
Between 2003 and 2017, 21 consecutive patients were operated on using this approach. The surgical technique is described and the visual outcomes, resection and recurrence rates, and complications are analyzed.
Twenty patients were included, with a median follow-up of 5.6 years. Regarding visual outcomes, among the 19 patients who had a visual impairment before surgery, 14 (74%) improved, 2 were stabilized (10%), and 2 (10%) showed a worsening of the most-compromised optic nerve and 1 (5%) of the less-compromised optic nerve. Gross total resection was achieved in 18 patients (90%) and 1 patient experienced recurrence 10 years after the initial surgery.
This approach allowed lower mobilization of the compromised optic nerve, better preservation of the vascularization of the visual pathways, and direct access to the inferomedial side of the optic nerve.
鞍结节脑膜瘤手术治疗中最具挑战性的方面之一是控制视神经内侧下方的受累情况，同侧入路无法直接观察到该部位，因此需要对视神经进行游离。
2003年至2017年期间，连续21例患者采用该入路进行手术。描述了手术技术，并分析了视觉结果、切除率、复发率和并发症。
纳入20例患者，中位随访时间为5.6年。关于视觉结果，在术前有视力障碍的19例患者中，14例（74%）视力改善，2例稳定（10%），2例（10%）最受损的视神经情况恶化，1例（5%）受损较轻的视神经情况恶化。18例患者（90%）实现了全切除，1例患者在初次手术后10年复发。
该入路可减少对视神经的游离，更好地保留视觉通路的血管化，并能直接到达视神经内侧下方。
