同侧和对侧经颅入路切除偏一侧鞍结节脑膜瘤的回顾性分析  

Retrospective comparative analysis of ipsilateral or contralateral transcranial approach for unilateral resection of tuberculum sellae meningioma

作　　者：杨照玉 王晓红 岳文峰 贾增强 YANG Zhaoyu;WANG Xiaohong;YUE Wenfeng(Department of Neurosurgery,Dongying People’s Hospital,Shandong,Dongying 257091,China)

机构地区：[1]山东省东营市人民医院神经外科,257091 [2]山东省东营市人民医院康复医学科,257091

出　　处：《临床外科杂志》2022年第10期944-947,共4页Journal of Clinical Surgery

摘　　要：目的探讨同侧或对侧经颅入路行鞍结节脑膜瘤(TSM)手术病人的长期视觉和嗅觉预后及复发率。方法回顾性分析2012年3月~2018年4月在我院神经外科接受手术治疗的偏一侧TSM病人44例。根据视神经主要受压侧,选择同侧或对侧入路手术。评估手术结局以及视力、视野改善情况和并发症。结果术前视力下降40例,术后18例视力完全恢复,10例有不同程度的视力改善,8例视力不变,4例视力进一步恶化。术前视野缺损42例,20例完全恢复,12例有明显改善,2例视野保持稳定,4例术后出现长期加重的视觉障碍。对侧入路更有利于TSM病人术后视野缺损的改善(OR=0.379,95%CI=0.125~0.954,P=0.038)。然而对侧入路术后嗅神经损伤率较高(45.0%vs.12.5%,P=0.016)。94.4%(17/18)对侧入路病人和50.0%(6/12)同侧入路病人对侵犯视神经管的肿瘤实现大体全切除(P=0.005)。随访期间,5例(10.6%)复发,均为SimpsonⅣ级次全切除者(包括2例WHOⅡ级肿瘤)。结论通过对侧入路切除TSM似乎提供了更好的视野改善率和肿瘤大体全切率,但是增加了嗅神经损伤风险。Objective To investigate the long-term visual and olfactory prognosis and recurrence rate of patients with tuberculum sellae meningioma(TSM)operated by the ipsilateral or contralateral transcranial approach.Methods Retrospective analysis was made on 44 patients with unilateral TSM who received surgical treatment in neurosurgery department of our hospital from March 2012 to April 2018.The ipsilateral or contralateral approach was selected according to the main compressed side of the optic nerve.The surgical outcome,visual acuity,visual field improvement and complications were evaluated.Results The visual acuity decreased in 40 cases before operation,recovered completely in 18 cases,improved in 10 cases,remained unchanged in 8 cases,and deteriorated further in 4 cases.Among 42 cases with visual field defect before operation,20 cases were completely recovered,12 cases were significantly improved,2 cases had stable visual field,and 4 cases had long-term visual impairment after operation.The contralateral approach was more conducive to the improvement of visual field defect in patients with TSM after surgery(OR=0.379,95%CI=0.125~0.954,P=0.038).However,the rate of olfactory nerve injury after contralateral approach was higher(45.0%vs.12.5%,P=0.016).94.4%(17/18)of patients with contralateral approach and 50.0%(6/12)of patients with ipsilateral approach achieved gross total resection of tumors invading the optic canal(P=0.005).During the follow-up period,5 cases(10.6%)recurred,all of them were Simpson GradeⅣsubtotal resection(including 2 WHO GradeⅡ).Conclusion Resection of TSM via contralateral approach seems to provide better visual field improvement rate and overall tumor resection rate,but increases the risk of olfactory nerve injury.

关 键 词：鞍结节脑膜瘤 同侧入路 对侧入路 切除程度 

分 类 号：R739.45[医药卫生—肿瘤]