Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Oper Neurosurg (Hagerstown). 2022 Feb 1;22(2):e95-e99. doi: 10.1227/ONS.0000000000000027.
There is no consensus on the optimal surgical approach for managing optic nerve gliomas. For solely intraorbital tumors, a single-stage lateral orbitotomy approach for resection may be performed, but when the nerve within the optic canal is affected, two-stage cranial and orbital approaches are often used. The authors describe their technique to safely achieve aggressive nerve resection to minimize the probability of recurrence that might affect the optic tracts, optic chiasm, and contralateral optic nerve.
A 28-yr-old woman presented with painless progressive vision loss, resulting in blindness. The second of 2 transorbital biopsies was diagnostic and consistent with low-grade glioma. The lesion continued to grow on serial imaging. The patient was offered a globe-sparing operative approach, with aggressive resection of the lesion to minimize the probability of tumor recurrence, which could possibly affect vision in her contralateral eye. The patient did well postoperatively, with clean tumor margins on pathological analysis and no evidence of residual on imaging. On postoperative examination, she had a mild ptosis, which was nearly resolved at her 6-wk outpatient follow-up.
This aggressive single-stage en bloc resection of an optic nerve glioma can achieve excellent tumor margins and preservation of extraocular muscle function.
对于视神经胶质瘤的治疗，目前尚无关于最佳手术方法的共识。对于单纯眶内肿瘤，可以采用单一阶段的外侧眶切开术进行切除，但当视神经管内的神经受到影响时，通常采用两阶段的颅眶入路。作者描述了一种安全的激进神经切除技术，以最大程度地降低可能影响视束、视交叉和对侧视神经的复发概率。
一名 28 岁女性因无痛性进行性视力丧失而就诊，最终导致失明。第 2 次经眶活检具有诊断意义，符合低度胶质瘤。该病变在连续影像学检查中持续生长。患者被提供了一种眼球保留手术方法，采用激进的肿瘤切除术，以最大程度地降低肿瘤复发的概率，这可能会影响她对侧眼睛的视力。术后患者恢复良好，病理分析显示肿瘤切缘干净，影像学检查未见残留。术后检查发现患者轻度上睑下垂，6 周门诊随访时已基本恢复。
这种激进的视神经胶质瘤单一阶段整块切除术可以实现极佳的肿瘤边界和眼外肌功能的保留。
