Department of Neurosurgery, North University Hospital, APHM-AMU, Chemin des Bourrely, 13015, Marseille, France.
Department of Statistical Analysis, Faculté Des Sciences Médicales Et Paramédicales, Aix-Marseille Université (AMU), 27 bd Jean Moulin, 13385, Marseille, France.
Neurosurg Rev. 2021 Dec;44(6):3581-3591. doi: 10.1007/s10143-021-01536-y. Epub 2021 Apr 22.
Most of tuberculum sellae meningiomas (TSM) show asymmetric growth. They are usually resected through ipsilateral approaches. The access of the inferior-medial side of the ipsilateral optic nerve might be challenging, which result in increased manipulation of the compromised optic nerve. The contralateral approach has been described to avoid these technical difficulties. Assessing the long-term visual and olfactory outcome, as well as recurrence rate in patients operated for TSM through ipsilateral or contralateral approaches. Single center retrospective cohort study about 94 patients operated on between March 2000 and April 2018. Seventy percent of the preoperative visual acuity loss totally resolved (44%) or showed varying degrees of improvement (26%) after surgery. Seventy-two percent of the preoperative visual field defects evolved favorably (44% recovery, 28% improvement). Eight patients showed aggravated visual disturbances (9%). A contralateral approach seemed to be predictive of visual field defects improvement after surgery (OR = 0.4), with borderline significant results (p = .08). There was a higher rate of postoperative olfactory nerve impairment after a contralateral approach (37% vs 17%, p = .03). Total removal of the tumor fragment entering the optic canal was accomplished in 96% in the contralateral vs 75% in the ipsilateral group (p = .04). The 2-, 5-, and 7-year tumor progression-free survival were 100% in the Simpson grade 2 group, and 85% (n = 17), 74% (n = 11), and 67% (n = 5) in the Simpson grade 4 group, respectively (p = .00). Resection of tuberculum sellae meningiomas through a contralateral approach seems to provide better visual outcome and tumor control at the cost of increased olfactory nerve disorders.
大多数鞍结节脑膜瘤（TSM）呈不对称性生长。它们通常通过同侧入路进行切除。同侧视神经的下内侧入路可能具有挑战性，这会导致对受损视神经的操作增加。已经描述了对侧入路来避免这些技术困难。评估通过同侧或对侧入路对 TSM 进行手术的患者的长期视力和嗅觉结果以及复发率。一项关于 2000 年 3 月至 2018 年 4 月期间接受手术的 94 例患者的单中心回顾性队列研究。70%的术前视力丧失完全恢复（44%）或术后有不同程度的改善（26%）。72%的术前视野缺损得到改善（44%恢复，28%改善）。8 名患者出现视力障碍加重（9%）。对侧入路似乎是术后视野缺损改善的预测因素（OR=0.4），结果具有边缘显著意义（p=0.08）。对侧入路后嗅觉神经损伤的发生率更高（37%比 17%，p=0.03）。肿瘤碎片进入视神经管的完全切除在对侧组中完成了 96%，而在同侧组中仅完成了 75%（p=0.04）。Simpson 分级 2 组的 2、5 和 7 年肿瘤无进展生存率为 100%，而 Simpson 分级 4 组分别为 85%（n=17）、74%（n=11）和 67%（n=5）（p=0.00）。通过对侧入路切除鞍结节脑膜瘤似乎可以提供更好的视力结果和肿瘤控制，但嗅觉神经疾病的发生率增加。
