Yoo Jihwan, Lim Seung Hun, Jung In-Ho, Park Hun Ho, Han Jinu, Hong Chang-Ki
Department of Neurosurgery (JY, SHL, IHJ, HHP), Brain Tumor Center, Gangnam Severance Hospital, Yonsei University, Seoul, Korea ; Yonsei University College of Medicine (JY), Seoul, Republic of Korea ; Department of Ophthalmology (JH), Gangnam Severance Hospital, Yonsei University, Seoul, Republic of Korea ; and Department of Neurosurgery (CKH), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea .
J Neuroophthalmol. 2022 Mar 1;42(1):e209-e216. doi: 10.1097/WNO.0000000000001473. Epub 2021 Dec 28.
During the surgical resection of petroclival meningiomas, preserving the cranial nerves is crucial. The abducens nerve is particularly vulnerable during surgery. However, the preoperative risk factors and postoperative prognosis of abducens nerve palsy (ANP) are poorly understood.
We retrospectively analyzed 70 patients who underwent surgery for petroclival meningiomas between May 2010 and December 2019, divided into gross-total resection (GTR) and subtotal resection (STR) groups. The relationship of preoperative clinical factors with the incidence and recovery of postoperative ANP was analyzed.
Postoperative ANP was observed in 23 patients (32.9%). Multivariable logistic regression revealed that the tumor-to-cerebellar peduncle T2 imaging intensity index (TCTI) (P < 0.001) and internal auditory canal invasion (P = 0.033) contributed to postoperative ANP. GTR was achieved in 37 patients (52.9%), and 10 (27.0%) of them showed ANP. STR was achieved in 33 patients (47.1%), and 13 (39.4%) of them showed ANP. Recovery from ANP took a median of 6.6 months (range, 4.5-20.3 months). At 6 months after the operation, recovery of the abducens nerve function was observed in 16 patients (69.0%); of whom, 4 (40.0%) were in the GTR group and 12 (92.3%) were in the STR group (P = 0.025).
TCTI and internal auditory canal invasion were the risk factors for postoperative ANP. Although intentional STR did not prevent ANP immediately after the operation, recovery of the abducens nerve function after surgery was observed more frequently in the STR group than in the GTR group.
在岩斜区脑膜瘤手术切除过程中，保留颅神经至关重要。外展神经在手术中尤其容易受损。然而，外展神经麻痹（ANP）的术前危险因素和术后预后尚不清楚。
我们回顾性分析了2010年5月至2019年12月期间接受岩斜区脑膜瘤手术的70例患者，分为全切除（GTR）组和次全切除（STR）组。分析术前临床因素与术后ANP发生率及恢复情况的关系。
23例患者（32.9%）术后出现ANP。多因素logistic回归显示，肿瘤与小脑脚T2成像强度指数（TCTI）（P<0.001）和内听道侵犯（P=0.033）与术后ANP有关。37例患者（52.9%）实现了GTR，其中10例（27.0%）出现ANP。33例患者（47.1%）实现了STR，其中13例（39.4%）出现ANP。ANP恢复的中位时间为6.6个月（范围4.5 - 20.3个月）。术后6个月，16例患者（69.0%）观察到外展神经功能恢复；其中，GTR组4例（40.0%），STR组12例（92.3%）（P = 0.025）。
TCTI和内听道侵犯是术后ANP的危险因素。虽然有意进行STR并不能在术后立即预防ANP，但STR组术后外展神经功能恢复的发生率高于GTR组。
