Cler Samuel J, Dunn Gavin P, Zipfel Gregory J, Dacey Ralph G, Chicoine Michael R
Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States.
J Neurol Surg B Skull Base. 2022 May 3;84(3):201-209. doi: 10.1055/a-1774-6281. eCollection 2023 Jun.
A low subfrontal dural opening technique that limits brain manipulation was assessed in patients who underwent frontotemporal approaches for anterior fossa lesions. A retrospective review was performed for cases using a low subfrontal dural opening including characterization of demographics, lesion size and location, neurological and ophthalmological assessments, clinical course, and imaging findings. A low subfrontal dural opening was performed in 23 patients (17F, 6M), median age of 53 years (range 23-81) with a median follow-up duration of 21.9 months (range 6.2-67.1). Lesions included 22 meningiomas (nine anterior clinoid, 12 tuberculum sellae, and one sphenoid wing), one unruptured internal carotid artery aneurysm clipped during a meningioma resection, and one optic nerve cavernous malformation. Maximal possible resection was achieved in all cases including gross total resection in 16/22 (72.7%), near total in 1/22 (4.5%), and subtotal in 5/22 (22.7%) in which tumor involvement of critical structures limited complete resection. Eighteen patients presented with vision loss; 11 (61%) improved postoperatively, three (17%) were stable, and four (22%) worsened. The mean ICU stay and time to discharge were 1.3 days (range 0-3) and 3.8 days (range 2-8). A low sub-frontal dural opening for approaches to the anterior fossa can be performed with minimal brain exposure, early visualization of the optico-carotid cistern for cerebrospinal fluid release, minimizing need for fixed brain retraction, and Sylvian fissure dissection. This technique can potentially reduce surgical risk and provide excellent exposure for anterior skull base lesions with favorable extent of resection, visual recovery, and complication rates.
在接受额颞入路治疗前颅窝病变的患者中，评估了一种限制脑操作的低位额下硬脑膜切开技术。对采用低位额下硬脑膜切开术的病例进行了回顾性分析，包括人口统计学特征、病变大小和位置、神经和眼科评估、临床病程及影像学检查结果。23例患者（17例女性，6例男性）接受了低位额下硬脑膜切开术，年龄中位数为53岁（范围23 - 81岁），随访时间中位数为21.9个月（范围6.2 - 67.1个月）。病变包括22例脑膜瘤（9例前床突、12例鞍结节和1例蝶骨嵴）、1例在脑膜瘤切除术中夹闭的未破裂颈内动脉瘤以及1例视神经海绵状畸形。所有病例均实现了最大可能切除，其中16/22例（72.7%）为全切除，1/22例（4.5%）为近全切除，5/22例（22.7%）为次全切除，关键结构受肿瘤侵犯限制了完全切除。18例患者存在视力丧失；11例（61%）术后改善，3例（17%）稳定，4例（22%）恶化。重症监护病房（ICU）平均住院时间和出院时间分别为1.3天（范围0 - 3天）和3.8天（范围2 - 8天）。对于前颅窝入路，低位额下硬脑膜切开术可在最小限度脑暴露的情况下进行，能早期显露视交叉池以释放脑脊液，减少对脑的固定牵拉需求，并减少外侧裂分离。该技术可能降低手术风险，并为前颅底病变提供良好的显露，切除范围良好，视力恢复佳，并发症发生率低。
