Graillon Thomas, Regis Jean, Barlier Anne, Brue Thierry, Dufour Henry, Buchfelder Michael
Neurosurgery Department, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, CHU Timone, Marseille, France,
Aix-Marseille University, INSERM, MMG, Marseille, France,
Neuroendocrinology. 2020;110(9-10):780-796. doi: 10.1159/000509090. Epub 2020 Jun 3.
Parasellar spaces remain particularly singular, comprising the most important neurovascular structures such as the internal carotid artery and optic, oculomotor, and trigeminal nerves. Meningiomas are one of the most frequent tumors arising from parasellar spaces. In this location, meningiomas remain mostly benign tumors with WHO grade I and a meningothelial subtype. Progestin intake should be investigated and leads mostly to conservative strategies. In the case of benign nonsymptomatic tumors, observation should be proposed. Tumor growth will lead to the proposition of surgery or radiosurgery. In the case of an uncertain diagnosis and an aggressive pattern, a precise diagnosis is required. For cavernous sinus and Meckel's cave lesions, complete removal is rarely considered, leading to the proposition of an endoscopic endonasal or transcranial biopsy. Optic nerve decompression could also be proposed via these approaches. A case-by-case discussion about the best approach is recommended. A transcranial approach remains necessary for tumor removal in most cases. Vascular injury could lead to severe complications. Cerebrospinal fluid leakage, meningitis, venous sacrifice, visual impairment, and cranial nerve palsies are more frequent complications. Pituitary dysfunctions are rare in preoperative assessment and in postoperative follow-up but should be assessed in the case of meningiomas located close to the pituitary axis. Long-term follow-up is required given the frequent incomplete tumor removal and the risk of delayed recurrence. Radiosurgery is relevant for small and well-limited meningiomas or intra-cavernous sinus postoperative residue, whereas radiation therapy and proton beam therapy are indicated for large, extended, nonoperable meningiomas. The place of the peptide receptor radionuclide therapyneeds to be defined. Targeted therapy should be considered in rare, recurrent, and aggressive parasellar meningiomas.
鞍旁间隙情况特殊，包含颈内动脉以及视神经、动眼神经和三叉神经等最重要的神经血管结构。脑膜瘤是鞍旁间隙最常见的肿瘤之一。在此部位，脑膜瘤大多为世界卫生组织一级的良性肿瘤，且为脑膜上皮亚型。应调查孕激素摄入情况，这大多会促使采取保守策略。对于良性无症状肿瘤，建议进行观察。肿瘤生长会促使考虑手术或放射外科治疗。在诊断不明确且表现侵袭性的情况下，则需要精确诊断。对于海绵窦和梅克尔腔病变，很少考虑完全切除，因此会建议采用内镜经鼻或经颅活检。也可通过这些方法进行视神经减压。建议针对最佳治疗方法进行个案讨论。在大多数情况下，仍需要采用经颅方法来切除肿瘤。血管损伤可能导致严重并发症。脑脊液漏、脑膜炎、静脉牺牲、视力损害和脑神经麻痹是更常见的并发症。垂体功能障碍在术前评估和术后随访中很少见，但对于位于垂体轴附近的脑膜瘤应进行评估。鉴于肿瘤切除常常不完全且存在延迟复发风险，需要进行长期随访。放射外科适用于小的、边界清晰的脑膜瘤或海绵窦内术后残留，而放射治疗和质子束治疗适用于大的、范围广的、无法手术的脑膜瘤。肽受体放射性核素治疗的地位有待确定。对于罕见的、复发性的和侵袭性的鞍旁脑膜瘤，应考虑靶向治疗。
