Hirsch W L, Sekhar L N, Lanzino G, Pomonis S, Sen C N
Department of Radiology, Presbyterian University Hospital, Pittsburgh, PA 15213.
AJR Am J Roentgenol. 1993 May;160(5):1083-8. doi: 10.2214/ajr.160.5.8470581.
The purpose of this study was to determine if it is possible to predict complications of surgery on cavernous sinus meningiomas on the basis of preoperative MR and CT findings.
We retrospectively reviewed the CT, MR, and postoperative clinical findings in 65 consecutive patients with pathologically proved cavernous sinus meningiomas who had surgery during the period 1985-1991. Tumors were categorized on the basis of their relationship to the cavernous carotid artery. The presence of tumor in three anatomic sites (the sella, the sphenoid sinus, and the orbital apex) was also correlated with surgical complications.
Category 1 tumors, which do not completely encircle the cavernous carotid artery, were dissected without injury, sacrifice, or grafting of the artery in 91% of cases. Category 2 lesions completely encircle the artery but do not narrow its lumen; they could be dissected from the cavernous carotid artery without arterial injury in 61% of cases, but imaging failed to discriminate differences within this group. Category 3 lesions, which completely encircle and narrow the cavernous carotid artery, are usually difficult to dissect free from the artery. The categories also correlated with recovery of extraocular motility; 84% of category 1 lesions compared with only 36% of category 2 or 3 lesions will recover to good or excellent extraocular motility after cavernous sinus surgery. Tumor involvement of the sella, orbital apex, and sphenoid sinus correlated with postoperative endocrine dysfunction, decreased visual acuity, and CSF leak, respectively.
Imaging studies can frequently predict the difficulty of resecting cavernous sinus meningiomas from the cavernous carotid artery and the likelihood of permanent loss of extraocular motility after surgery on these lesions. This information is helpful in appropriate preoperative planning and in providing information to patients about to undergo such surgery.
本研究的目的是确定是否可以根据术前磁共振成像（MR）和计算机断层扫描（CT）结果预测海绵窦脑膜瘤手术的并发症。
我们回顾性分析了1985年至1991年期间连续65例经病理证实为海绵窦脑膜瘤且接受手术治疗患者的CT、MR及术后临床资料。根据肿瘤与海绵窦段颈内动脉的关系对肿瘤进行分类。肿瘤在三个解剖部位（蝶鞍、蝶窦和眶尖）的存在情况也与手术并发症相关。
1类肿瘤未完全包绕海绵窦段颈内动脉，91%的病例在手术中该动脉未受损伤、未被牺牲或未进行血管移植。2类病变完全包绕动脉但未使其管腔变窄；61%的病例可将其与海绵窦段颈内动脉分离而不损伤动脉，但影像学检查未能区分该组内的差异。3类病变完全包绕并使海绵窦段颈内动脉管腔变窄，通常难以与动脉游离。这些分类也与眼球运动功能的恢复相关；海绵窦手术后，84%的1类病变患者与仅36%的2类或3类病变患者的眼球运动功能恢复为良好或优秀。蝶鞍、眶尖和蝶窦的肿瘤累及分别与术后内分泌功能障碍、视力下降和脑脊液漏相关。
影像学检查常常能够预测从海绵窦段颈内动脉切除海绵窦脑膜瘤的难度以及这些病变手术后眼球运动功能永久性丧失的可能性。这些信息有助于进行适当的术前规划，并为即将接受此类手术的患者提供信息。
