Duangprasert Gahn, Nimmannitya Pree, Yindeedej Vich, Noiphithak Raywat, Goto Takeo
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, 99/209 Moo 18 Pahol-Yothin Rd., Klong Neung, Klong Luang, Pathum Thani, 12120, Thailand.
Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, 545-8585, Osaka, Japan.
Acta Neurochir (Wien). 2025 Feb 1;167(1):31. doi: 10.1007/s00701-025-06446-2.
There is a lack of available data regarding the incidence and characteristics of optic canal invasion (OCI) in large midline non-tuberculum sellae anterior skull base meningiomas (NTSAM), specifically those originating predominantly from the olfactory groove and planum sphenoidale. This study aims to describe the incidence and characteristics of OCI as well as clinical and visual outcomes following extensive tumor resection with optic canal exploration in intra-optic canal tumor removal. In addition, the predictive performance of OCI by preoperative magnetic resonance imaging (MRI) is investigated.
From 2016 to 2024, we retrospectively reviewed 24 patients with large midline NTSAM who underwent extensive tumor resection in our institution. The OCI was evaluated and compared between preoperative MRI and intraoperative findings. The OCI was classified as follows. Type 1 represented no invasion, type 2 represented secondary invasion, type 3 represented partial wall invasion (two subtypes), and type 4 represented invasion into the superior-medial-inferior walls of the optic canal. Visual functions were assessed before and after surgery.
Among 24 patients, a mean tumor size of 57.2 mm (range 39.0-79.0). The OCI was observed intraoperatively in 22 cases (91.7%), with 19 cases exhibiting bilateral OCI. Among the 48 optic canals in the 24 patients, 18 (37.5%) were type 4, 12 (25.0%) were type 3-inferomedial, 9 (18.8%) were type 3-superomedial, and 2 (4.2%) were type 2, where 7 (14.6%) optic canals were without OCI. A significant correlation was observed between intraoperative OCI and the tumors that exhibited involvement of the tuberculum sellae (TS) on MRI (p < 0.001). For patients with visual impairment, the vision in 27 of 38 (71.1%) eye sides showed improvement following the surgery. There was 1 (4.2%) case of tumor recurrence at the mean follow-up time of 27.3 months (range 4-73 months).
A high incidence of OCI was observed in the large midline NTSAM. The identification of TS involvement on MRI can serve as a strong predictor of OCI. Therefore, optic canal exploration to remove the optic canal invasion during the surgical removal of these particular tumors should be contemplated to attain radical tumor resection to enhance the possibility of improving visual function and reduce the risk of recurrence.
关于大型中线非蝶骨嵴鞍结节前颅底脑膜瘤（NTSAM），特别是主要起源于嗅沟和蝶骨平台的脑膜瘤，视神经管侵犯（OCI）的发生率和特征的可用数据匮乏。本研究旨在描述OCI的发生率和特征，以及在视神经管内肿瘤切除术中进行广泛肿瘤切除并探查视神经管后的临床和视觉结果。此外，还研究了术前磁共振成像（MRI）对OCI的预测性能。
2016年至2024年，我们回顾性分析了在我院接受广泛肿瘤切除的24例大型中线NTSAM患者。对视神经管侵犯情况在术前MRI和术中发现之间进行评估和比较。OCI分类如下。1型表示无侵犯，2型表示继发性侵犯，3型表示部分壁侵犯（两个亚型），4型表示侵犯视神经管的上、中、下壁。在手术前后评估视觉功能。
24例患者中，肿瘤平均大小为57.2mm（范围39.0 - 79.0mm）。术中观察到22例（91.7%）存在OCI，其中19例为双侧OCI。在24例患者的48条视神经管中，18条（37.5%）为4型，12条（25.0%）为3型 - 下内侧型，9条（18.8%）为3型 - 上内侧型，2条（4.2%）为2型，7条（14.6%）视神经管无OCI。术中OCI与MRI显示累及蝶骨嵴（TS）的肿瘤之间存在显著相关性（p < 0.001）。对于有视力障碍的患者，38只患眼中有27只（71.1%）术后视力改善。在平均随访时间27.3个月（范围4 - 73个月）时，有1例（4.2%）肿瘤复发。
在大型中线NTSAM中观察到OCI的高发生率。MRI上TS受累的识别可作为OCI的有力预测指标。因此，在手术切除这些特定肿瘤时，应考虑探查视神经管以去除视神经管侵犯，以实现肿瘤的根治性切除，提高改善视觉功能的可能性并降低复发风险。
