Kim Yeong Jin, Moon Kyung-Sub, Jang Woo-Youl, Jung Tae-Young, Kim In-Young, Jung Shin
J Neurosurg. 2022 Jul 22;138(3):598-609. doi: 10.3171/2022.5.JNS212899. Print 2023 Mar 1.
Tuberculum sellae meningiomas (TSMs) present a burdensome surgical challenge because of their adjacency to vital neurovascular structures. The contralateral subfrontal approach provides an outstanding corridor for removing a TSM with an excellent visual outcome and limited complications. The authors present their long-term surgical experience in treating TSMs via the contralateral subfrontal approach and discuss patient selection, surgical techniques, and clinical outcomes.
Between 2005 and 2021, the authors used the contralateral subfrontal approach in 74 consecutive patients presenting with TSMs. The surgical decision-making process and surgical techniques are described, and the clinical outcomes were retrospectively analyzed.
The mean patient age was 54.4 years, with a female predominance (n = 61, 82%). Preoperatively, 61 patients (82%) had vision symptoms and 73 (99%) had optic canal invasion by tumor. Gross-total resection was achieved in almost all patients (n = 70, 95%). The visual function improvement and stabilization rate was 91% (67/74). Eight patients (11%) showed a worsening of visual function on the less-compromised (approach-side) optic nerve. There was no occurrence of cerebrospinal fluid leakage. Four patients (5%) experienced recurrences after the initial operation (mean follow-up duration 63 months). There were no deaths in this study.
The contralateral subfrontal approach provides a high chance of complete tumor removal and visual improvement with limited complications and recurrences, especially when the tumor is in a unilateral or midline location causing unilateral visual symptoms or bilateral asymmetrical visual symptoms, regardless of tumor size or encasement of major vessels. With the appropriate patient selection, surgical technique, and familiarity with surrounding neurovascular structures, this approach is reliable for TSM surgery.
鞍结节脑膜瘤（TSM）因其毗邻重要神经血管结构，给手术带来了艰巨挑战。对侧额下入路为切除TSM提供了一条极佳的通道，视觉效果良好且并发症有限。作者介绍了他们通过对侧额下入路治疗TSM的长期手术经验，并讨论了患者选择、手术技术和临床结果。
2005年至2021年期间，作者对74例连续的TSM患者采用了对侧额下入路。描述了手术决策过程和手术技术，并对临床结果进行了回顾性分析。
患者平均年龄为54.4岁，女性占优势（n = 61，82%）。术前，61例患者（82%）有视力症状，73例（99%）有肿瘤侵犯视神经管。几乎所有患者（n = 70，95%）均实现了肿瘤全切。视觉功能改善和稳定率为91%（67/74）。8例患者（11%）在受损较轻（手术入路侧）的视神经上出现了视觉功能恶化。未发生脑脊液漏。4例患者（5%）在初次手术后复发（平均随访时间63个月）。本研究中无死亡病例。
对侧额下入路提供了较高的肿瘤全切机会和视觉改善机会，并发症和复发有限，特别是当肿瘤位于单侧或中线位置，导致单侧视觉症状或双侧不对称视觉症状时，无论肿瘤大小或主要血管包绕情况如何。通过适当的患者选择、手术技术以及对周围神经血管结构的熟悉程度，该入路在TSM手术中是可靠的。
