Park Hun Ho, Sung Kyoung Su, Moon Ju Hyung, Kim Eui Hyun, Kim Sun Ho, Lee Kyu-Sung, Hong Chang-Ki, Chang Jong Hee
Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea.
Neurosurg Rev. 2020 Feb;43(1):313-322. doi: 10.1007/s10143-019-01147-8. Epub 2019 Aug 3.
The lateral supraorbital (LSO) approach is a minimally invasive modification of the pterional approach. The authors assess the surgical indications and esthetic benefits of the LSO approach in comparison with the pterional approach for parachiasmal meningiomas. From April 2013 to May 2017, a total of 64 patients underwent surgery for parachiasmal meningiomas. Among them, tumor resection was performed with the LSO approach for 34 patients and pterional approach for 30 patients. A retrospective analysis was done on tumor characteristics, surgical outcome, approach-related morbidity, and esthetic outcome between the two approaches. Gross total resection was achieved in 33 of 34 patients (97.1%) with the LSO approach. There were no differences in tumor size, origin, consistency, internal carotid artery encasement, cranial nerve adhesion, and optic canal invasion between the two approaches. The most common tumor origin was the tuberculum sellae for both the LSO and pterional approaches. For tumors with preoperative visual compromise, immediate visual outcome improved or remained stable in 76% and 80.9% with the LSO and pterional approaches, respectively. Surgery time, surgical bleeding, hospital length of stay, and esthetic outcome were significantly shorter and superior with the LSO approach. There were no differences in surgical morbidity and brain retraction injury between the two approaches. The LSO approach can provide a safe, rapid, and minimally invasive exposure for parachiasmal meningiomas compared with the pterional approach. Surgeons must consider tumor size, origin, and extent in determining the resectability of the tumor rather than the extent of exposure.
眶上外侧（LSO）入路是翼点入路的一种微创改良术式。作者比较了LSO入路与翼点入路治疗鞍旁脑膜瘤的手术适应证及美学优势。2013年4月至2017年5月，共有64例患者接受了鞍旁脑膜瘤手术。其中，34例患者采用LSO入路进行肿瘤切除，30例患者采用翼点入路。对两种入路的肿瘤特征、手术结果、入路相关并发症及美学效果进行了回顾性分析。采用LSO入路的34例患者中，33例（97.1%）实现了肿瘤全切。两种入路在肿瘤大小、起源、质地、颈内动脉包绕、脑神经粘连及视神经管侵犯方面无差异。LSO入路和翼点入路最常见的肿瘤起源均为鞍结节。对于术前有视力损害的肿瘤，LSO入路和翼点入路术后即时视力改善或保持稳定的比例分别为76%和80.9%。LSO入路的手术时间、手术出血量、住院时间及美学效果均明显更优。两种入路在手术并发症及脑牵拉损伤方面无差异。与翼点入路相比，LSO入路可为鞍旁脑膜瘤提供安全、快速且微创显露。外科医生在确定肿瘤的可切除性时，必须考虑肿瘤大小、起源及范围，而非显露范围。
