Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava, 70852 Ostrava, Czech Republic.
Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic.
Medicina (Kaunas). 2022 Aug 22;58(8):1137. doi: 10.3390/medicina58081137.
The clinical management of parasellar meningiomas (PM) is challenging due to their intimate association with critical neurovascular structures. Consensus regarding the recommended treatment protocol is lacking. This study will evaluate patients' visual outcomes following endoscopic transnasal optic nerve decompression (ETOND) and will investigate the possibility of reducing the rate of complications associated with stereotactic radiosurgery (SRS).
Retrospective analysis was conducted on all patients who underwent ETOND for PM between 2013 and 2020. The study comprised 12 patients (7 women and 5 men aged 36-75 years; mean, 55.2 years; median, 57.6 years) in which 14 optic nerve decompression procedures were carried out. Patients were followed up for 6 to 86 months (mean, 29.3 months; median, 25 months). There were five cases of spheno-orbital meningioma, four cases of cavernous sinus meningioma, and one case each of petro-clival meningioma, optic nerve sheath meningioma, and planum sphenoidale/tuberculum sellae meningioma. Visual outcome was evaluated and any postoperative complications noted.
Improvements in visual acuity were noted in 10 of 14 eyes (71.4%) 3 to 6 months postoperation. Visual acuity remained stable in the remaining four eyes. No deterioration of visual acuity was noted during the follow-up period. In total, 9 of the 12 patients underwent SRS. No tumor growth was determined, while reduction in tumor volume was noted in five patients following SRS. No complications associated with SRS or the surgical procedure were noted.
ETOND appears to be a promising technique for increasing rates of improved visual function, while reducing the risk of post SRS-related complications. In combination with subsequent SRS, it is an ideal treatment modality in the management of parasellar meningiomas. Confirmation of our findings would require a larger, prospective multicenter study.
由于鞍旁脑膜瘤（PM）与关键的神经血管结构密切相关，因此其临床治疗颇具挑战性。目前，对于推荐的治疗方案尚未达成共识。本研究旨在评估内镜经鼻视神经减压术（ETOND）治疗 PM 后患者的视力预后，并探讨降低与立体定向放射外科（SRS）相关并发症发生率的可能性。
回顾性分析了 2013 年至 2020 年间接受 ETOND 治疗的所有 PM 患者。本研究共纳入 12 例患者（7 名女性，5 名男性；年龄 36-75 岁，平均 55.2 岁，中位数 57.6 岁），共进行了 14 次视神经减压术。患者的随访时间为 6-86 个月（平均 29.3 个月，中位数 25 个月）。其中，5 例为蝶眶型脑膜瘤，4 例为海绵窦型脑膜瘤，1 例为岩斜型脑膜瘤、视神经鞘脑膜瘤、蝶骨平台/鞍结节脑膜瘤。评估了患者的视力预后，并记录了任何术后并发症。
术后 3-6 个月，14 只眼中的 10 只（71.4%）视力得到改善。其余 4 只眼的视力保持稳定。在随访期间，没有出现视力恶化的情况。12 例患者中，有 9 例接受了 SRS。SRS 后，未发现肿瘤生长，5 例患者的肿瘤体积缩小。SRS 或手术过程中均未发生相关并发症。
ETOND 似乎是提高视觉功能改善率、降低 SRS 相关并发症风险的一种有前途的技术。与后续 SRS 相结合，它是治疗鞍旁脑膜瘤的理想治疗方法。需要更大规模的前瞻性多中心研究来证实我们的发现。
