Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
Oper Neurosurg (Hagerstown). 2019 Nov 1;17(5):470-480. doi: 10.1093/ons/opz001.
Tuberculum sellae meningiomas frequently extend into the optic canals, which leads to a progressive longitudinal visual loss. Therefore, in addition to tumor removal, unroofing and exploration inside the optic canal are important procedures.
To perform endoscopic endonasal tumor removal with optic canal decompression for small primary or recurrent meningiomas associated with a progressive visual loss at the inferior-medial optic canal, which corresponded to a blind corner in the ipsilateral pterional/subfrontal approach.
We retrospectively reviewed 2 cases of primary meningiomas that arose in the inferior-medial optic canal and 4 recurrent cases from the remnant inside the medial optic canal that had previously undergone craniotomy for tuberculum sellae meningiomas, and were treated by the endoscopic endonasal approach.
All tumors were detectable and could be removed without manipulation of the affected optic nerve. The average maximum diameter of the tumor was 8.4 mm (range: 5-12 mm). Two patients who had a long history of progressive visual disturbance and papillary atrophy did not recover from severe visual disturbances postoperatively. However, others showed considerable improvement, maintaining postoperative visual function during follow-up. There were no postoperative complications.
Endoscopic endonasal approach has several advantages for meningiomas in the medial optic canal and associated with progressive visual disturbance. In surgery of tuberculum sellae meningiomas, optic canal decompression and exploration inside the optic canal are important procedures to avoid symptomatic recurrence, which may be facilitated by the endoscopic endonasal approach. Papillary atrophy and duration of visual deterioration are predictive factors for postoperative visual outcomes.
鞍结节脑膜瘤常向视神经管内延伸，导致进行性纵向视力丧失。因此，除了肿瘤切除外，视神经管的开窗和探查也是重要的手术步骤。
对于位于视神经管中下内侧、与同侧翼点/额下入路盲角相对应的、与进行性下内侧视神经管视野丧失相关的小型原发性或复发性脑膜瘤，采用经鼻内镜颅底肿瘤切除术联合视神经管减压术。
我们回顾性分析了 2 例起源于视神经管中下内侧的原发性脑膜瘤和 4 例复发性脑膜瘤，这些肿瘤均来自之前因鞍结节脑膜瘤而行开颅手术时残留于内侧视神经管内的肿瘤，采用经鼻内镜入路进行治疗。
所有肿瘤均能被发现并切除，无需操作受影响的视神经。肿瘤的平均最大直径为 8.4mm（范围：5-12mm）。2 例有较长时间进行性视力障碍和视乳头萎缩病史的患者术后视力严重障碍未能恢复。然而，其他患者的视力有了明显改善，在随访期间保持了术后的视觉功能。无术后并发症。
对于内侧视神经管内的脑膜瘤及与之相关的进行性视力障碍，经鼻内镜入路具有多种优势。在鞍结节脑膜瘤手术中，视神经管减压和视神经管内探查是避免症状性复发的重要步骤，经鼻内镜入路可能有助于这些手术步骤的完成。视乳头萎缩和视力恶化时间是术后视力结果的预测因素。
