Department of Ophthalmology and Visual Sciences (Kellogg Eye Center) (YZ, CA, EA, LB, HG, EM, JT); Department of Radiology (Neuroradiology) (JK); Department of Neurosurgery (SS, JT); and Department of Neurology (JT), University of Michigan.
J Neuroophthalmol. 2021 Dec 1;41(4):e548-e559. doi: 10.1097/WNO.0000000000001205.
Intracranial meningiomas that arise from the medial sphenoid ridge, anterior clinoid process, tuberculum sellae, or planum sphenoidale often impair vision by compressing the optic nerves and optic chiasm. Although many studies have reported visual outcome following surgery for these tumors, documentation has often been incomplete and not validated by patient self-report.
Retrospective study of 40 patients drawn from a single, academic, medical center. We used a unique method of assessing visual outcome based on whether the change in visual function affected the preoperatively better-sighted or worse-sighted eye in the belief that this method would correlate with effects on activities of daily living (ADL). To elicit patient self-reports of those effects, we conducted telephone interviews of 25 patients with a standard questionnaire. We also assessed putative ophthalmic, imaging, and surgical predictors of visual outcome.
Visual improvement occurred in 61% of patients with preoperative monocular visual dysfunction, but only 22% of patients reported improvement in their ability to conduct ADL, and 17% lost vision. Visual outcomes were better in patients with preoperative binocular visual dysfunction, where visual improvement occurred in 73% and no patient lost vision in the preoperatively better-sighted eye. However, only 27% of patients with preoperative binocular visual dysfunction reported improvement in their ability to conduct ADL. Long duration of vision impairment, presence of optic disc pallor, large tumor size, and imaging-based preoperative optic canal involvement did not preclude a favorable visual outcome. Aggressive surgical reduction in displacement of the optic nerves was not necessary to obtain a favorable visual outcome and sometimes led to an unfavorable visual outcome.
In this study, surgery often improved vision, especially in patients with preoperative binocular visual dysfunction. But patients indicated that the effect on their ability to perform ADL was more modest. Moreover, 17% of patients with preoperative monocular visual dysfunction lost vision in the only affected eye, often to a considerable degree. In those patients, surgery would be justified primarily to relieve the concern of having a large brain tumor and to prevent tumor growth. Preoperative ophthalmic and imaging features poorly predicted visual outcomes. Favorable visual outcomes occurred without aggressive surgical debulking of the tumors.
颅内脑膜瘤起源于蝶骨体、前床突、鞍结节或蝶骨平台，常因压迫视神经和视交叉而导致视力受损。尽管许多研究报告了这些肿瘤手术后的视力结果，但这些报告往往不完整，也未通过患者的自我报告得到验证。
对来自单一学术医疗中心的 40 名患者进行回顾性研究。我们使用了一种独特的方法来评估视力结果，该方法基于视觉功能的变化是否影响术前视力较好的或较差的眼睛，我们相信这种方法与日常生活活动（ADL）的影响相关。为了引出患者对这些影响的自我报告，我们对 25 名患者进行了电话访谈，并使用了标准问卷。我们还评估了可能的眼科、影像学和手术因素对视功能结果的预测作用。
术前单眼视力障碍的患者中，有 61%的患者视力改善，但只有 22%的患者报告 ADL 能力改善，17%的患者视力丧失。术前双眼视力障碍的患者视力结果更好，其中 73%的患者视力改善，术前视力较好的眼睛没有患者视力丧失。但是，只有 27%的术前双眼视力障碍的患者报告 ADL 能力改善。视力障碍持续时间长、视盘苍白、肿瘤大、影像学提示术前视神经管受累并不能排除良好的视力结果。视神经压迫的积极手术减压并非获得良好视力结果所必需，有时甚至会导致不良的视力结果。
在这项研究中，手术常常改善视力，尤其是在术前双眼视力障碍的患者中。但患者表示，对其 ADL 能力的影响较为温和。此外，17%的术前单眼视力障碍的患者在唯一受影响的眼睛中视力丧失，且通常程度较大。在这些患者中，手术主要是为了缓解对大脑内有大肿瘤的担忧，并防止肿瘤生长。术前眼科和影像学特征对视功能结果的预测作用较差。没有进行积极的肿瘤切除术也能获得良好的视力结果。
