Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
China National Clinical Research Center for Neurological Diseases, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
Acta Neurochir (Wien). 2020 Jun;162(6):1249-1257. doi: 10.1007/s00701-020-04262-4. Epub 2020 Feb 26.
Ocular motor dysfunction is one of the most common postoperative complications of petroclival meningioma. However, its incidence, recovery rate, and independent risk factors remain poorly explored.
A prospective analysis of 31 petroclival meningiomas was performed. Operative approaches were selected by utilizing a new 6-region classification of petroclival meningiomas we proposed. Two scores were used to evaluate the functions of the oculomotor and abducens nerves. Pearson correlation analysis and binary logistic regression analysis were used to identify independent risk factors for intraoperative oculomotor and abducens nerve injury.
Postoperative new-onset dysfunctions in the pupillary light reflex and eye/eyelid movements as well as abducens paralysis were detected in eight (25.8%), ten (32.3%) and twelve (38.7%) cases, respectively. Their corresponding recovery rates after 6 months of follow-up were 75% (6/8), 80% (8/10), and 83.3% (10/12), respectively, and their mean times to start recovery were 4.03, 2.43, and 2.5 months, respectively. Tumor invasion into the suprasellar region/sphenoid sinus was the only risk factor for dysfunctions in both the pupillary light reflex (p = 0.001) and eye/eyelid movements (p = 0.002). Intraoperative utilization of the infratrigeminal interspace was the only risk factor for dysfunction in eyeball abduction movement (p = 0.004).
Dysfunctions of the oculomotor and abducens nerves recovered within 6 months postoperatively. Tumor extension into the suprasellar region/sphenoid sinus was the only risk factor for oculomotor nerve paralysis. Eye/eyelid movements were more sensitive than the pupillary light reflex in reflecting nerve dysfunctions. Intraoperative utilization of the infratrigeminal interspace was the only risk factor for abducens nerve paralysis.
眼球运动功能障碍是岩斜区脑膜瘤术后最常见的并发症之一。然而，其发病率、恢复率及独立危险因素仍未得到充分探讨。
前瞻性分析 31 例岩斜区脑膜瘤患者。我们采用新提出的岩斜区脑膜瘤 6 分区分类法选择手术入路。使用两种评分系统评估动眼神经和展神经功能。采用 Pearson 相关分析和二项逻辑回归分析识别术中动眼神经和展神经损伤的独立危险因素。
术后 8 例（25.8%）、10 例（32.3%）和 12 例（38.7%）患者出现瞳孔光反射、眼球/眼睑运动及展神经麻痹新发病变，6 个月随访时恢复率分别为 75%（6/8）、80%（8/10）和 83.3%（10/12），开始恢复的平均时间分别为 4.03、2.43 和 2.5 个月。肿瘤向鞍上区/蝶窦侵犯是瞳孔光反射（p=0.001）和眼球/眼睑运动障碍（p=0.002）的唯一危险因素。经颅中窝入路是眼球外展运动障碍（p=0.004）的唯一危险因素。
动眼神经和展神经功能障碍可在术后 6 个月内恢复。肿瘤向鞍上区/蝶窦侵犯是动眼神经麻痹的唯一危险因素。眼球运动较瞳孔光反射更能敏感地反映神经功能障碍。经颅中窝入路是展神经麻痹的唯一危险因素。
