目的:尽管内镜经鼻入路(EEA)是一种广泛接受的颅底肿瘤治疗方法,EEA在嗅沟脑膜瘤(OGMs)中的具体用途存在争议,与文献中报道的可变结果。我们回顾了一位外科医生的OGM切除术的手术结果,包括手术方法,手术细微差别,和结果,重点关注与患者选择相关的因素,这些因素有利于EEA而不是经颅入路。
方法:我们回顾了13例内镜经鼻内镜切除嗅沟脑膜瘤的临床资料。患者特征,临床特征,手术结果,并对并发症进行分析。根据术前和术后MRI的体积分析确定切除程度。
结果:使肿瘤难以完全进入的解剖学特征是横向延伸超过中眶和前部延伸至镰刀。11/13例(84.6%)实现了SimpsonI级切除。术前平均肿瘤体积为8.99cm3(范围为2.19-16.79cm3),92%的肿瘤为WHOⅠ级,我们证明了2例气味保留,可能有单侧小肿瘤和局限于筛板前部或后部的肿瘤。术后脑脊液漏出率为7.7%,无预防性腰脑脊液引流。CSF泄漏后感染并发症后的死亡率为7.7%(n=1)。
结论:内镜鼻内切除嗅沟脑膜瘤是一种有效和安全的手术方法,其结果和并发症发生率与经颅方法相当。主要考虑因素包括仔细选择患者,并熟悉针对这种特定肿瘤类型的鼻内镜入路的技术细微差别。
OBJECTIVE: Though the endoscopic endonasal approach (EEA) is a widely accepted treatment for skull base tumors, the specific use of EEA for olfactory groove meningiomas (OGMs) is debated, with variable outcomes reported in the literature. We review the surgical results of OGM resections for one surgeon including the operative approach, surgical nuances, and outcomes, with a focus on factors relating to patient selection which favor EEA over transcranial approaches.
METHODS: We retrospectively reviewed thirteen cases of endoscopic endonasal resection of olfactory groove meningiomas. Patient characteristics, clinical characteristics, surgical outcomes, and complications were analyzed. Extent of resection was determined based on volumetric analysis of pre- and postoperative MRI.
RESULTS: Anatomic characteristics that render a tumor difficult to access fully are lateral extension beyond the mid-orbit and anterior extension to the falx. Simpson Grade I resection was achieved in 11/13 (84.6 %) cases. Mean pre-operative tumor volume was 8.99 cm3 (range 2.19-16.79 cm3), and 92 % of tumors were WHO grade I. We demonstrate 2 cases of smell preservation, possible with small unilateral tumors and tumors that are confined to either the anterior or posterior portion of the cribriform plate. The post-operative CSF leak rate was 7.7 %, without prophylactic lumbar CSF drainage. The mortality rate was 7.7 % (n = 1) after infectious complications following CSF leak.
CONCLUSIONS: Endoscopic endonasal resection of olfactory groove meningiomas is an effective and safe operative method with outcomes and complication rates comparable to transcranial approaches. Key considerations include careful patient selection and familiarity with technical nuances of endoscopic endonasal approach for this specific tumor type.