目的:鞍区脑膜瘤(TSM)通常位于视神经和视交叉附近,因此,手术的主要目的是增强或稳定患者的视力。因此,作者对他们17年的翼状入路经验进行了回顾性回顾,以确定切除率。神经系统的结果,和视觉结果。
方法:对2003年9月至2020年12月在作者机构接受TSM手术的患者进行回顾性评估。患者人口统计学,肿瘤特征,手术参数,术后视觉结果,并对并发症进行分析。评估总切除率(GTR)和次全切除率(STR),以及手术入路对视觉结果的影响。
结果:共有71名平均年龄为56.9±14.3岁的患者被纳入研究。平均肿瘤体积为10.2±12.8cm3。术后,38.7%的患者经历了视觉改善,45.2%视力稳定,16.1%显示视力下降。同侧或对侧手术方法是根据受影响最大的视力进行的。两种方法在术后视觉结果上没有观察到显着差异。GTR达到84.0%,STR达到16.0%。3例患者发生轻微并发症(4.2%),4例(5.6%)出现严重并发症。7例患者(9.8%)在53个月后出现复发性肿瘤生长。GTR后无进展生存期为123.9±12.9个月,STR后59.3±13.2个月。
结论:这项研究强调了这样一个发现,即使用经颅翼点入路可以成功切除TSM,并发症风险低,视力结果充分。有必要进行更大样本量的进一步研究,以证实这些发现并优化TSM切除术的手术策略。
OBJECTIVE: Tuberculum sellae meningiomas (TSMs) are typically in the proximity of the optic nerves and the optic chiasm, thus making the primary aim of surgery the enhancement or stabilization of the patients\' visual acuity. The authors therefore undertook a retrospective review of their 17-year experience with the pterional approach to ascertain the resection rate, neurological outcome, and visual outcome.
METHODS: Patients who underwent TSM surgery between September 2003 and December 2020 at the authors\' institution were retrospectively evaluated. Patient demographics, tumor characteristics, surgical parameters, postoperative visual outcomes, and complications were analyzed. Gross-total resection (GTR) and subtotal resection (STR) rates were assessed, along with the impact of surgical approach on visual outcomes.
RESULTS: A total of 71 patients with a mean age of 56.9 ± 14.3 years were enrolled in the study. The mean tumor volume was 10.2 ± 12.8 cm3. Postoperatively, 38.7% of patients experienced visual improvement, 45.2% had stable visual acuity, and 16.1% showed visual deterioration. Ipsilateral or contralateral surgical approaches were performed based on the side of the most affected visual acuity. No significant difference in postoperative visual outcomes was observed between the two approaches. GTR was achieved in 84.0% and STR in 16.0%. Minor complications occurred in 3 patients (4.2%), while major complications were found in 4 patients (5.6%). Seven patients (9.8%) showed recurrent tumor growth after 53 months. Progression-free survival after GTR was 123.9 ± 12.9 months, and it was 59.3 ± 13.2 months after STR.
CONCLUSIONS: This study highlighted the finding that TSMs can be successfully resected using a transcranial pterional approach with a low risk of complications and sufficient visual outcomes. Further studies with larger sample sizes are warranted to confirm these findings and optimize surgical strategies for TSM resection.