Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute, Lucknow, India.
Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute, Lucknow, India.
World Neurosurg. 2024 Oct;190:e355-e363. doi: 10.1016/j.wneu.2024.07.137. Epub 2024 Jul 23.
BACKGROUND/OBJECTIVE: Visual impairment affects 55%-80% of medial sphenoid wing meningiomas (mSWMs) patients, making optic nerve decompression a critical surgical goal. Complete resection often leads to better visual outcomes. However, involvement of critical neurovascular structures increases postoperative morbidity and mortality, with vascular injury reported in 18%-20% of cases. This study aims to evaluate the relationship between the extent of resection (EOR), visual outcomes, and the incidence of vascular injury, seeking to identify the optimal surgical approach for mSWMs.
We retrospectively analyzed data from patients undergoing surgery for mSWM at our tertiary care center from January 2001 to December 2021. Inclusion criteria included histopathologically confirmed globoid mSWMs (N = 89). Patients with recurrent tumors (n = 14) or lost to follow-up (n = 9) were excluded. We classified patients into 2 groups based on EOR using Simpson's grade: Group 1 (good-resection,Simpson Grade-I/II,n = 51) and Group 2 (poor-resection,Simpson Grade III/IV, n = 15).
Among 66 (=N) patients, visual impairment was the most common symptom (81.8%), followed by headaches (77.3%) and seizures (27%). T2-hyperintensity on magnetic resonance imaging [(OR:5.4, 95%CI:1.5-18.6) (P-value<0.01)] and cavernous sinus-extension [(OR:3.9, 95%CI:1.1-13.1) (p-value-0.02)] were independent significant predictors of poor resection. Visual status was preserved in 90.3% of Group-1 and 86.6% of Group-2, with no significant difference based on EOR. Vascular involvement was noted in 87.9%, higher than the vessel encasement (>180) (57.6%, P = 0.04). Vessel injury occurred in 7.8% of Group-1 and 6.6% of Group-2, with no significant impact on EOR.
Cavernous sinus-extension and T2-hyperintensity predict poor resection rates in mSWMs. While visual outcomes are not directly affected by EOR, long-term visual status may decline due to tumor recurrence and radiotherapy. Vascular injury incidence is not associated with EOR. Thus, the "maximal safe resection" of mSWMs involves a surgical strategy balancing targeted aggressive and conservative resection for maximal cytoreduction and functional preservation.
背景/目的：视觉障碍影响 55%-80%的蝶骨翼内侧脑膜瘤（mSWM）患者，视神经减压成为关键的手术目标。完全切除通常会带来更好的视觉效果。然而，涉及关键的神经血管结构会增加术后发病率和死亡率，血管损伤的报道比例为 18%-20%。本研究旨在评估切除程度（EOR）、视觉结果和血管损伤发生率之间的关系，旨在为 mSWM 确定最佳手术方法。
我们回顾性分析了 2001 年 1 月至 2021 年 12 月在我们的三级护理中心接受 mSWM 手术的患者数据。纳入标准包括经组织病理学证实的球形 mSWM（N=89）。排除复发性肿瘤患者（n=14）或失访患者（n=9）。我们根据 Simpson 分级将患者分为两组：EOR 良好组（Simpson Grade-I/II，n=51）和 EOR 不良组（Simpson Grade III/IV，n=15）。
在 66（=N）名患者中，视力障碍是最常见的症状（81.8%），其次是头痛（77.3%）和癫痫发作（27%）。磁共振成像上的 T2 高信号[（OR：5.4，95%CI：1.5-18.6）（P 值<0.01）]和海绵窦延伸[（OR：3.9，95%CI：1.1-13.1）（p 值<0.02）]是 EOR 不良的独立显著预测因素。EOR 良好组（Group-1）和 EOR 不良组（Group-2）中分别有 90.3%和 86.6%的患者保留了视力，两组之间没有显著差异。血管受累率为 87.9%，高于血管包裹（>180°）（57.6%，P=0.04）。EOR 良好组（Group-1）中有 7.8%的患者和 EOR 不良组（Group-2）中有 6.6%的患者发生了血管损伤，EOR 没有显著影响。
海绵窦延伸和 T2 高信号预测 mSWM 的低切除率。虽然 EOR 不会直接影响视力结果，但由于肿瘤复发和放疗，长期视力可能会下降。血管损伤的发生率与 EOR 无关。因此，mSWM 的“最大安全切除”涉及一种手术策略，平衡靶向侵袭性和保守性切除，以实现最大的细胞减灭和功能保留。
