Matsuo Satoshi, Amano Toshiyuki, Yamashita Sojiro, Miyamatsu Yuichiro, Nakamizo Akira
Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Chuo-ku, Fukuoka, Japan.
J Neurol Surg B Skull Base. 2021 May 3;83(Suppl 3):e635-e636. doi: 10.1055/s-0041-1727148. eCollection 2022 Aug.
Tuberculum sellae meningiomas pose significant challenges because they are surrounded by crucial neurovascular structures, such as the optic and oculomotor nerves, pituitary stalk, internal carotid artery and its branches, and the anterior cerebral arteries. Even if small, such meningiomas frequently extend to the optic canal that is considered a poor prognostic factor for vision. In this video clip, we illustrate the case of a 60-year-old female who had an approximately 3-cm tuberculum sellae meningioma with optic canal involvement. She underwent surgical resection of the tumor through a pterional approach. After extradural optic canal unroofing, detaching, devascularizing, and debulking the tumor, careful dissection of the meningioma from the surrounding tissues was performed. Next, the tumor extensions into both of the optic canals were removed. Finally, coagulation and resection of the tumor origin on the dura of the tuberculum sellae following Simpson's grade-I resection were performed. Histopathology revealed that the tumor was a World Health Organization (WHO) grade-I meningioma. The patient had an uneventful postoperative course and her visual acuity was preserved, with no visual field defect on postoperative visual examination. In this video, the basic surgical techniques in performing extradural optic canal unroofing, preserving the arachnoid plane, and stay in collect layer, which is the essential technique for dissecting meningiomas and for preserving neurovascular structures, are demonstrated. The link to the video can be found at: https://youtu.be/vD54Iji0C4Q .
鞍结节脑膜瘤带来了重大挑战，因为它们被关键的神经血管结构所包围，如视神经、动眼神经、垂体柄、颈内动脉及其分支以及大脑前动脉。即使肿瘤很小，这类脑膜瘤也常常延伸至视神经管，而这被认为是影响视力预后的不良因素。在本视频片段中，我们展示了一位60岁女性的病例，她患有一个约3厘米大小且累及视神经管的鞍结节脑膜瘤。她通过翼点入路接受了肿瘤的手术切除。在硬膜外打开视神经管、分离肿瘤、使其血管离断并减瘤后，仔细地将脑膜瘤与周围组织进行了分离。接下来，切除了延伸至双侧视神经管内的肿瘤部分。最后，按照辛普森一级切除标准，对鞍结节硬膜上的肿瘤起源部位进行了凝固和切除。组织病理学检查显示该肿瘤为世界卫生组织（WHO）一级脑膜瘤。患者术后恢复顺利，视力得以保留，术后视力检查未发现视野缺损。在本视频中，展示了硬膜外打开视神经管、保留蛛网膜层面以及停留在集合层的基本手术技巧，这是切除脑膜瘤和保留神经血管结构的关键技术。该视频链接可在：https://youtu.be/vD54Iji0C4Q 找到。
