背景:视力障碍影响55-80%的内侧蝶骨翼脑膜瘤(mSWMs)患者,使视神经(ON)减压成为关键的手术目标。1-3完全切除通常会导致更好的视觉结果。关键神经血管结构的参与增加术后发病率和死亡率,18-20%的病例报告血管损伤3,5-7本研究旨在评估切除程度(EOR)之间的关系,视觉结果,和血管损伤的发生率,
方法:我们回顾性分析了2001年1月至2021年12月在我们的三级医疗中心接受mSWM手术的患者的数据。纳入标准包括组织病理学证实的球状mSWM(N=89)。肿瘤复发(n=14)或随访失败(n=9)的患者被排除在外。我们根据EOR使用Simpson的分级将患者分为两组:第1组(切除良好,辛普森一级/二级,n=51)和第2组(切除不良,辛普森三级/四级,n=15)。
结果:在66名(=N)患者中,视力障碍是最常见的症状(81.8%),其次是头痛(77.3%)和癫痫(27%)。MRI的T2-高强度[(OR:5.4,95CI:1.5-18.6)(p值<0.01)]和CS延伸[(OR:3.9,95CI:1.1-13.1)(p值-0.02)]是切除不良的独立重要预测因素。在组1的90.3%和组2的86.6%中,视觉状态得以保留,基于EOR没有显着差异。血管受累占87.9%,高于船只外壳(>1800)(57.6%,p=0.04)。血管损伤发生在组1的7.8%和组2的6.6%,对EOR没有显著影响。
结论:CS-延伸和T2-高强度预测mSWMs的低切除率。虽然视觉结果不受EOR的直接影响,长期视力状态可能由于肿瘤复发和放疗而下降。血管损伤的发生率与EOR无关。因此,mSWMs的"最大安全切除"涉及一种手术策略,即在有针对性的侵袭性和保守性切除与最大细胞减少和功能保留之间取得平衡.
OBJECTIVE: Visual impairment affects 55%-80% of medial sphenoid wing meningiomas (mSWMs) patients, making optic nerve decompression a critical surgical goal. Complete resection often leads to better visual outcomes. However, involvement of critical neurovascular structures increases postoperative morbidity and mortality, with vascular injury reported in 18%-20% of cases. This study aims to evaluate the relationship between the extent of resection (EOR), visual outcomes, and the incidence of vascular injury, seeking to identify the optimal surgical approach for mSWMs.
METHODS: We retrospectively analyzed data from patients undergoing surgery for mSWM at our tertiary care center from January 2001 to December 2021. Inclusion criteria included histopathologically confirmed globoid mSWMs (N = 89). Patients with recurrent tumors (n = 14) or lost to follow-up (n = 9) were excluded. We classified patients into 2 groups based on EOR using Simpson\'s grade: Group 1 (good-resection,Simpson Grade-I/II,n = 51) and Group 2 (poor-resection,Simpson Grade III/IV, n = 15).
RESULTS: Among 66 (=N) patients, visual impairment was the most common symptom (81.8%), followed by headaches (77.3%) and seizures (27%). T2-hyperintensity on magnetic resonance imaging [(OR:5.4, 95%CI:1.5-18.6) (P-value<0.01)] and cavernous sinus-extension [(OR:3.9, 95%CI:1.1-13.1) (p-value-0.02)] were independent significant predictors of poor resection. Visual status was preserved in 90.3% of Group-1 and 86.6% of Group-2, with no significant difference based on EOR. Vascular involvement was noted in 87.9%, higher than the vessel encasement (>1800) (57.6%, P = 0.04). Vessel injury occurred in 7.8% of Group-1 and 6.6% of Group-2, with no significant impact on EOR.
CONCLUSIONS: Cavernous sinus-extension and T2-hyperintensity predict poor resection rates in mSWMs. While visual outcomes are not directly affected by EOR, long-term visual status may decline due to tumor recurrence and radiotherapy. Vascular injury incidence is not associated with EOR. Thus, the \"maximal safe resection\" of mSWMs involves a surgical strategy balancing targeted aggressive and conservative resection for maximal cytoreduction and functional preservation.