The School of Clinical Medicine, Fujian Medical University, Zhangzhou Affiliated Hospital of Fujian Medical University, Fuzhou, 350122, Fujian Province, China.
Department of Neurosurgery, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, Fujian Province, China.
Neurosurg Rev. 2023 Sep 12;46(1):240. doi: 10.1007/s10143-023-02151-9.
Optic canal unroofing (OCU) has gradually become a routine technique for tuberculum sellae meningiomas (TSMs) resection. This meta-analysis aimed to evaluate the efficacy and safety of OCU. A systematic review and meta-analysis of the published literature on this topic from 2003 to 2023 were conducted in accordance with the PRISMA guidelines. Rigorous statistical analysis with a p-value was performed for related change in visual improvement, gross total resection (GTR), visual deterioration, and olfactory nerve damage. The study included 15 articles with 384 patients in whom OCU was performed by the transcranial approach (TCA) or the endoscopic endonasal approach (EEA). Of these, 341 patients had preoperative visual loss, and 266 patients had postoperative visual recovery. The overall rate of visual improvement was 0.803 (95% CI: 0.733-0.874, p < 0.01). The rate of visual improvement in the EEA and TCA groups was 0.884 (95% CI: 0.803-0.965, p < 0.01) and 0.788 (95% CI: 0.700-0.875, p < 0.01). Further analysis of classification shows that the rate of visual improvement in Type I: < 2 cm was 0.889(95% CI: 0.739-0.969), Type II:2-4 cm was 0.844(95% CI: 0.755-0.910), Type III: > 4 cm was 0.500(95% CI: 0.068-0.932) and the total was 0.853(95% CI: 0.779-0.927 p < 0.01) with low heterogeneity of I = 20.80%.Twelve studies separately reported GTR with OCU was 293; the rate of GTR was 0.911 (95% CI: 0.848-0.961, p < 0.01). And the rate of GTR in Type I: < 2 cm was 0.933(95% CI: 0.817-0.986), Type II:2-4 cm was 0.880(95% CI: 0.800-0.936), Type III: > 4 cm was 0.600(95% CI: 0.147-0.947). The total was 0.897(95% CI: 0.830-0.965 p < 0.01) with low heterogeneity of I = 34.57%. The related complications of OCU were visual deterioration and olfactory nerve damage. Visual decline was reported in nine studies, and the rate was 0.077 (95% CI: 0.041-0.113, p < 0.01). Six studies reported olfactory nerve damage, and the overall rate was 0.054 (95% CI: 0.019-0.090, p < 0.01). OCU could significantly recover preoperative impaired vision and make GTR easier to achieve, which was also a safe and effective technique in TSM.
视神经管开放术（OCU）已逐渐成为鞍结节脑膜瘤（TSM）切除的常规技术。本荟萃分析旨在评估 OCU 的疗效和安全性。根据 PRISMA 指南，对 2003 年至 2023 年发表的关于该主题的文献进行了系统评价和荟萃分析。对于视觉改善、大体全切除（GTR）、视觉恶化和嗅神经损伤的相关变化，进行了严格的统计学分析，p 值<0.01。研究包括 15 篇文章，共 384 例患者接受了经颅入路（TCA）或内镜经鼻入路（EEA）的 OCU。其中，341 例患者术前有视力丧失，266 例患者术后视力恢复。总体视觉改善率为 0.803（95%CI：0.733-0.874，p<0.01）。EEA 和 TCA 组的视觉改善率分别为 0.884（95%CI：0.803-0.965，p<0.01）和 0.788（95%CI：0.700-0.875，p<0.01）。进一步的分类分析表明，I 型：<2cm 的视觉改善率为 0.889（95%CI：0.739-0.969），II 型：2-4cm 为 0.844（95%CI：0.755-0.910），III 型：>4cm 为 0.500（95%CI：0.068-0.932），总有效率为 0.853（95%CI：0.779-0.927，p<0.01），异质性低 I=20.80%。12 项研究分别报告了 OCU 下的 GTR 为 293 例；GTR 率为 0.911（95%CI：0.848-0.961，p<0.01）。I 型：<2cm 的 GTR 率为 0.933（95%CI：0.817-0.986），II 型：2-4cm 为 0.880（95%CI：0.800-0.936），III 型：>4cm 为 0.600（95%CI：0.147-0.947）。总有效率为 0.897（95%CI：0.830-0.965，p<0.01），异质性低 I=34.57%。OCU 的相关并发症为视力恶化和嗅神经损伤。9 项研究报告了视力下降，发生率为 0.077（95%CI：0.041-0.113，p<0.01）。6 项研究报告了嗅神经损伤，总发生率为 0.054（95%CI：0.019-0.090，p<0.01）。OCU 可以显著恢复术前受损视力，并使 GTR 更容易实现，这也是 TSM 的一种安全有效的技术。
