Postoperative improvement in visual function in patients with tuberculum sellae meningiomas: results of the extended transsphenoidal and transcranial approaches
Postoperative improvement in visual function in patients with tuberculum sellae meningiomas: results of the extended transsphenoidal and transcranial approaches
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DOI：
10.3171/jns-07/08/0337
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发表时间：
2007-08-01
影响因子：
4.1
通讯作者：
Nakao, Yuzo
中科院分区：
文献类型：
--
作者：
Kitano, Masahiko;Taneda, Mamoru;Nakao, Yuzo
Object.最近，扩大经蝶窦手术（ETSS）已成为鞍上脑膜瘤经颅手术（TCS）的替代方案，尽管ETSS的相对优势尚未确定。为了评价ETSS的有效性，作者分析了TCS和ETSS的手术结果。在12年的时间里，28例鞍结节脑膜瘤患者在近畿大学医院接受了肿瘤切除术。前12例患者接受了TCS，其余16例接受了ETSS。在TCS组中，所有病例的入路侧视神经管均无顶。ETSS组开放双侧视神经管，用腹筋膜和羟基磷灰石骨水泥修补颅底硬脑膜和骨缺损。半数病例同时行腰大池脑脊液引流。在对该连续系列患者的回顾性分析中，ETSS组的视力改善和术中失血量明显更好（分别为p = 0.010和p = 0.011），而两组之间的视野缺损改善、手术时间和肿瘤切除率无显著差异。在TCS组中观察到非视觉手术并发症，如CSF泄漏（1例患者）和穿通动脉梗死（3例患者）。在ETSS组中，脑脊液漏（2例患者）、嗅觉丧失（2例患者）和穿通动脉梗死（2例患者）均未发生。由于在视力改善方面的令人鼓舞的结果，ETSS可能是可以接受的鞍结节脑膜瘤的治疗。
Object. Recently, extended transsphenoidal surgery (ETSS) has become an alternative to transcranial surgery (TCS) for suprasellar meningiomas, although the relative benefits of ETSS have yet to be established. To evaluate the effectiveness of ETSS, the authors analyzed surgical outcomes of TCS and ETSS.Methods. During a 12-year period, 28 patients with meningiomas arising from the tuberculum sellae underwent tumor removal at Kinki University Hospital. The first 12 patients underwent TCS, and the remaining 16 underwent ETSS. In the TCS group, the optic canal on the approach side was unroofed in all cases. In the ETSS group bilateral optic canals were opened, and the dural and bone defects of the skull base were repaired using abdominal fascia and hydroxyapatite cement. In half of the cases, lumbar drainage of cerebrospinal fluid (CSF) was also performed.Results. In a retrospective analysis of this consecutive series of patients, improvement in visual acuity and intraoperative blood loss were significantly better in the ETSS group (p = 0.010 and p = 0.011, respectively), whereas improvement in visual field defects, operative times, and the tumor removal rate were not significantly different between the two groups. Nonvisual surgical complications such as CSF leakage (one patient) and infarction of a perforating artery (three patients) were observed in the TCS group. In the ETSS group, CSF leakage (two patients), anosmia (two patients), and infarction of a perforating artery (two patients) were observed.Conclusions. Given the encouraging results in improvement in visual acuity, ETSS may be acceptable for the treatment of tuberculum sellae meningiomas.