巨大鞍结节脑膜瘤手术的视力疗效及其影响因素分析

目的探讨巨大鞍结节脑膜瘤手术切除后的视力疗效及影响因素。方法回顾性分析23例巨大鞍结节脑膜瘤患者的临床资料,以单眼作为研究单位,对患者就诊的临床特点、肿瘤特点、手术切除程度、手术入路等进行单因素分析。结果本组共23例46只眼,均采取开颅显微手术切除,术后视力有效32只眼(69.6%),无效14只眼(30.4%)。对单眼视力预后有影响的单因素有:术前视力下降的程度及持续时间、肿瘤与视神经和邻近血管的关系。单眼术前视力0.1,同时视力损害持续时间12个月或肿瘤与视神经、邻近血管关系不紧密的患者术后视力预后较好。结论影响巨大鞍结节脑膜瘤术后视力疗效的因素有术前视力下降的程度及持续时间、肿瘤与视神经和邻近血管的关系。尽早就诊和手术治疗能改善视力预后,提高患者生活质量。     

鞍结节脑膜瘤42例临床分析

目的探讨鞍结节脑膜瘤的诊断及治疗.方法对42例鞍结节脑膜瘤的临床资料进行回顾性分析.结果肿瘤全切除28例,次全切除9例,部分切除5例,其中颅底重建5例.术后55%病人视力改善,大部分病人恢复正常工作.结论对首发症状为视力视野改变特别是伴持续性头痛者,应行CT或MRI检查,争取早期确诊;肿瘤形状及生长方向是影响肿瘤切除的主要因素,应肿瘤的大小及生长方向确定手术入路;细致的显微手术可以避免损伤鞍区的重要结构,对有颅底骨质破坏者需行颅底重建;应对鞍结节脑膜瘤进行细致分型,从而更有利于手术及估计预后.     

鞍结节脑膜瘤显微手术后视力恢复的影响因素

目的探讨鞍结节脑膜瘤的显微手术治疗和影响视力恢复的因素。方法显微手术切除34例鞍结节脑膜瘤,术前检查均有视力障碍,纵裂入路12例,额底入路9例,眶上锁孔入路10例,翼点入路3例。结果手术全切率为79.4%。术后视力改善27只,无明显变化25只,3例患者6只眼睛出现视力下降。结论显微手术是最佳的治疗方法 ,合适手术入路能够尽可能全切除肿瘤,减少对视神经损伤,促进术后视力恢复。     

伴有视力障碍的内侧型蝶骨嵴脑膜瘤治疗及预后分析

目的探讨伴有视力障碍的内侧型蝶骨嵴脑膜瘤的手术治疗及术后视力改善情况。方法回顾性分析我院手术治疗的32例伴有视力障碍的内侧型蝶骨嵴脑膜瘤患者临床资料及术后随访结果。结果32例内侧型蝶骨嵴脑膜瘤患者,视力改善20例,未改善12例;肿瘤全切21例,次全切除8例,大部切除3例。术前有视神经萎缩的8例患者,术后随访6例视力无变化,2例视力恶化。小型肿瘤手术后视力改善（改善率90．0％）优于肿瘤较大者（大型及巨大型50．0％）;肿瘤全切的患者视力改善（改善率81．0％）优于未行全切者（改善率27．3％）。结论手术后视力改善与术前肿瘤大小、是否全切及术前有无视神经萎缩有关。     

鞍结节脑膜瘤的手术切除与视力保护

目的 探讨鞍结节脑膜瘤术中保护视觉功能的手术技巧.方法 鞍结节脑膜瘤病人21例,男5例,女16例,以视力障碍为首发症状19例;采用翼点入路,以术侧视神经为标志,逐步显露对侧视神经、视交叉,行肿瘤囊内切除,最后探察视神经管口.结果 本组肿瘤全切除18例,大部分切除3例.术后视觉功能明显改善15例,无明显变化5例,视力下降1例.结论 避免对视交叉和视神经的直接操作和牵拉是保护视觉功能的关键.     

鞍结节脑膜瘤的临床特征及手术治疗（附21例报告）

目的探讨鞍结节脑膜瘤的临床特征及治疗策略。方法回顾性分析2003年10月2008年10月收治的21例鞍结节脑膜瘤患者的临床资料。结果21例肿瘤均全切。术后视力改善19例,无变化1例,死亡1例。结论鞍结节脑膜瘤临床表现以视力下降为主,合适的手术入路及术中对鞍结节周围重要结构的保护对改善患者的预后有重要帮助。     

鞍结节脑膜瘤的显微外科治疗

目的 探讨显微外科手术切除鞍结节脑膜瘤的方法及疗效.方法 回顾性分析15例鞍结节脑膜瘤的显微外科手术.结果 所有病例均通过显微外科手术切除,选择单侧额下入路8例,翼点及改良翼点入路5例,经眶上锁孔入路2例.肿瘤全切除(Simpson Ⅰ、Ⅱ级)11例,近全切除(Simpson Ⅲ级)4例.手术后视力改善7例,无改变3例,视力下降加重2例,1例术前双眼完全失明的术后无恢复,死亡1例.结论 全面的解剖知识及熟练的显微外科手术操作技巧是肿瘤全切及良好疗效的关键.     

鞍结节脑膜瘤的显微外科治疗(附30例报告)

目的探讨鞍结节脑膜瘤显微手术治疗效果。方法对30例行显微手术治疗的鞍结节脑膜瘤患者的临床资料及手术效果进行分析总结。结果肿瘤全切(Simpon分级Ⅰ、Ⅱ级)24例,次全切(Simpon分级Ⅳ级)4例,大部分切除2例。术中去骨瓣减压2例。手术死亡1例。术前有视力下降的26例患者中,术后早期视力改善20例,无变化4例,恶化2例。术后随访3～38个月,2例术中去骨瓣减压的患者分别于术后6个月及8个月时行颅骨缺损修补术;24例肿瘤全切病例中,3例患者有肿瘤复发,2例行二次手术,1例选择放射治疗。失访3例。结论鞍结节脑膜瘤位置深在,与周围血管神经等重要结构关系密切,但积极的显微外科手术治疗效果良好。     

经前纵裂大脑镰入路锁孔手术治疗鞍结节脑膜瘤

目的 探讨经前纵裂大脑镰入路锁孔手术治疗压迫视神经并累及视神经管的鞍结节脑膜瘤的疗效。方法 回顾性分析2017年5月~2021年5月经前纵裂大脑镰入路锁孔手术治疗的9例鞍结节脑膜瘤的临床资料。9例肿瘤压迫视神经并累及视神经管。结果 9例肿瘤均全切除,术后随访6个月~2年,无复发。术前15侧（83.33%）眼睛存在视力受损,术后均改善。术后出现假性脑膜膨出1例,无尿崩症。结论 对于压迫视神经并累及视神经管的鞍结节脑膜瘤,经前纵裂大脑镰入路锁孔手术提供了一种经颅入路替代方法,可以很好地暴露血管和视神经管,获得良好的手术效果。     

侵犯视神经管鞍区脑膜肿瘤术后视力影响因素分析

目的探讨改善侵犯视神经管的脑膜肿瘤术后视力水平的影响因素。方法收集侵犯视神经管的脑膜肿瘤患者的临床资料,logistic回归分析性别、年龄、肿瘤大小、术前视力、肿瘤切除程度、肿瘤粘连周围结构程度、视神经管减压时机和患者视力转归的关系。结果共55例,术后视力改善26例,无改善29例。早期硬膜外视神经管减压17例,视力好转15例;后期视神经管减压9例,视力好转5例;单纯刮除29例,视力好转6例。单因素分析提示切除级别、肿瘤粘连程度和早期硬膜外视神经管减压可影响术后视力改善;logistic回归分析显示早期硬膜外视神经管减压是改善术后视力的唯一保护因素。结论对于术前考虑已经侵犯视神经管的鞍区脑膜肿瘤,术中宜行早期硬膜外视神经管减压以改善患者术后视力。     

鞍区脑膜瘤的显微手术治疗及预后影响因素分析

目的 探讨鞍区脑膜瘤的手术方法及影响患者术后生活质量的因素。方法 回顾性分析2007年10月至2012年10月显微手术治疗的44例鞍区脑膜瘤患者的临床资料,所有患者出院后随访3~60月（平均22.8月）,术后3个月采用Karnofsky功能状态量表（KPS）评分评估患者生活质量,KPS评分≥80分为优秀,<80分为不优秀;采用Logistic回归分析影响患者术后生活质量的因素。结果 按Simpson分级标准:Ⅰ级5 例,1级22例,Ⅲ级5例,Ⅳ级12例。本组肿瘤全切除（Simpson分级Ⅰ～Ⅲ级）率为72.7%。术后死亡2例。Logistic回归分析显示,影响术后生活质量的因素有术后视力恢复情况、肿瘤与视神经的关系、肿瘤与颈内动脉及其分支的的关系。结论 对鞍区脑膜瘤患者,合适的手术入路、娴熟的显微操作技术、减少和避免对视神经、下丘脑、垂体等重要结构及其穿支血管的直接操作,是预防和减少术后并发症和提高术后生活质量的有效措施。     

影响经手术治疗鞍区脑膜瘤视力预后的因素

目的　分析影响经手术治疗鞍区脑膜瘤视力预后的因素。方法　收集以视力障碍为首发症状的鞍区脑膜瘤71例。先以双眼为单位,根据视力损伤评分表对其术后与术前的视力视野进行评分,以评分差来衡量预后并进行多重回归,筛选影响双眼视力预后的因素。再以单眼为单位,将术后视力以0 0 5为界分为2组,与其影响因素行单因素分析,再以0 .0 5、0 . 5和1 . 0为界分为4个等级,进行有序分类logistic回归,分析影响单眼术后视力的因素。结果　双眼视力的综合预后受其术前的评分及肿瘤切除程度的影响(B =- 0 . 1 0 9,P <0 . 0 5和B =7 4 .0 8,P <0 . 0 5) ;单眼的术后视力与其术前视力呈正相关(B =4 .2 55,P <0 .0 1 )与视乳头的病变程度及视神经的受累程度呈负相关(B =- 0 . 94 3,P <0 . 0 1和B =- 0 .830 ,P <0 . 0 5) ;术前视力低于0 .0 5、视乳头苍白萎缩或视神经管受累的眼球术后视力恢复到0 . 0 5以上的比例极小。结论　术前的视力、视乳头的病变程度、视神经的受累程度及肿瘤的切除程度对术后的视力恢复有影响。     

Microsurgical management of tuberculum sellae meningiomas by the frontolateral approach: surgical technique and visual outcome

Objectives

The aim of this study was to evaluate visual outcome in patients with tuberculum sellae meningioma (TSM) treated microsurgically using the frontolateral or fronto-orbital approach and optic canal unroofing to resect tumor involvement of the optic canal.

Methods

Data from 67 patients with TSMs who underwent microsurgical treatment by a frontolateral approach (n = 44) or fronto-orbital approach (n = 23) between January 2002 and December 2008 were retrospectively collected and analyzed. Change in visual function was evaluated as the main outcome.

Results

Total tumor resection was achieved in 62 of 67 cases (92.4%). Postoperative, visual acuity was improved in 87 eyes (64.9%) and unchanged in 39 eyes (29.1%), and the optic nerve was therefore preserved in 126 of 134 eyes (94.0%). Visual field deficits were improved or stable in 65 eyes, no patient experienced worsening of vision in both eyes. There was no mortality in our series.

Conclusions

The frontolateral approach with microsurgical dissection of the Sylvian fissure provides quick access to TSMs, which can be resected safely and totally. Visual function is improved and neurological and ophthalmological morbidity is minimal. Optic nerve decompression by intradural clinoidectomy and optic canal unroofing is likely to increase the rate of reducing or eliminating preoperative visual symptoms.     

创伤性视神经损伤预后影响因素分析及视神经管骨折手术策略选择

目的探讨视神经管减压术治疗创伤性视神经损伤（TON）的疗效,评估相关预后影响因素,并分析视神经管不同部位骨折手术策略选择。 方法回顾性分析空军军医大学第二附属医院神经外科自2011年1月至2020年6月收治的58例TON后行视神经减压术患者的临床资料,采用单因素和多因素Logistic回归分析评价预后的潜在影响因素。根据视神经管骨折位置的不同,选择开颅视神经减压术和经鼻内镜减压术评估不同术式对不同骨折位置患者的术后视力改善情况的影响。 结果58例TON患者均行视神经减压术,33例患者术后视力得到改善（改善组）,其中9例行开颅视神经管减压术,24例行经鼻内镜减压术;25例患者术后视力未得到改善（未改善组）,其中8例行开颅视神经管减压术,17例行经鼻内镜减压术。单因素和多因素Logistic回归分析确定术前视力及视神经管是否骨折是术后视力改善的独立影响因素,有光感者有效率明显高于无光感者,无视神经管骨折患者术后改善率明显高于有视神经管骨折患者。35例单发视神经管骨折患者中,视神经管内下壁骨折使用经鼻内镜视神经减压有更好的预后,开颅减压则对于外上壁骨折更有益。 结论视神经管减压术治疗TON总体有较好的效果,尤其是对于术前尚存光感的患者。对于视神经管骨折患者应根据骨折位置选择合理的手术方式进行视神经减压。     

Visual outcome after fronto-temporo-orbito-zygomatic approach combined with early extradural and intradural optic nerve decompression in tuberculum and diaphragma sellae meningiomas

Object

The surgical challenge of the treatment of tuberculum (TSMs) and diaphragma sellae meningiomas (DSMs) is to preserve or improve the visual function. Extradural and intradural optic nerve decompression should reduce surgical trauma of the nerve achieving a good visual result.

Methods

We reported 37 consecutive TSMs and DSMs operated through fronto-temporo-orbito-zygomatic approach with extradural unroofing of the optical canal and early intradural incision of the dural sheath. Visual data were recorded measuring the visual impairment score (VIS), the visual acuity (VA), the visual field (VF) and the postoperative improvement.

Results

A good visual outcome (VIS improved or unchanged) was obtained in 97.2% of patients (35/36). The evaluation of 72 eyes showed a good outcome (VA and VF unchanged or improved) in 98.6% (71/72 eyes). The degree of preoperative VA and VF impairment was the only factor correlating with the postoperative improvement of VA (P < .001 and P = .018) and VF defect (P < .001). Worsening of visual function occurred in 1/37 patient (2.7%).

Conclusion

Using this surgical technique we achieved a high improvement rate of visual defects and a low frequency of worsening.     

Treatment outcomes after surgical resection of midline anterior skull base meningiomas at a single center

Meningiomas of the midline anterior skull base (ASB) typically grow around the optic chiasm. These tumors can displace or adhere to the optic apparatus, resulting in visual abnormalities. For this reason, in most studies of surgically resected meningiomas, only surgical and visual outcomes have been evaluated. However, in this study, we assessed overall clinical outcomes and the effects of different surgical approaches on outcomes. Clinical data for 126 patients who were treated surgically for midline ASB meningiomas between 1994 and 2009 were collected and reviewed retrospectively. The mean follow-up duration was 39 months (range: 0.5–146 months). Most procedures were performed via a pterional approach and did not require an aggressive skull base approach. Clinical outcomes were evaluated using our own criteria, and potential predictive factors for visual and clinical outcomes were tested statistically. The tumor control rate was 83% (105/126). Immediate postoperative visual status and optic canal involvement were correlated with visual outcome. Of the patients who ultimately had improved visual status, only six were originally categorized as having severe visual impairment (all were only able to count fingers). In terms of clinical outcome, 41 patients were classified as “excellent”, 32 as “good”, 29 as “fair”, and 20 as “poor”. A symptom duration of less than six months, less severe preoperative visual symptoms of the affected eye, and the extent of resection were all correlated with improved clinical outcome. Involvement of the optic canal, adherence of the tumor to the optic nerve, and major arterial encasement by the tumor were associated with poor clinical outcome. We recommend that in patients with unilateral severe visual impairment, the focus should be on improving visual function in the contralateral eye. Preoperative and postoperative evaluation of several variables allows for the prediction of clinical and visual outcomes.     

Visual impairment complicated with meningioma]

Among 106 patients of meningioma surgically experienced the past 10 years between 1981 and 1990, twelve of meningioma with progressive visual impairment were analyzed in relation to postoperative visual outcome. There were four males and eight females, and the age ranged from 33 to 61 years with the average 48 years. The distribution of tumor location was 6 cases in tuberculum sellae, 3 cases in the inner side of sphenoid ridge, and 3 cases in olfactory groove. The size of tumor in each case was 2 to 7 cm in diameter, and in 8 cases more than 3 cm. The duration of visual disturbance was between 3 months and 10 years with the average 3 years. For all cases, surgical removal of the tumor was performed totally by pterional and bifrontal approach. Consequently, 58.3% of 7 cases had improved vision postoperatively, 16.7% of 2 cases remained unchanged, and 25.0% of 3 cases were worse, including one case of malignant meningioma, Visual outcome was mainly affected by a duration of symptoms, a tumor size, a preoperative visual impairment, and in special, a situation of optic nerve where compression of tumor itself and adherence to the surrounding tissues took place. On operation, great care should be paid for a case of long-standing, severe visual disturbance as demonstrating hemianopsia with visual narrowing less than 50 degree by perimetry, and also for preservation of the feeding arteries of optic nerves.     

Posner-Schlossman syndrome and nonarteritic anterior ischemic optic neuropathy.

A 41-year-old woman with acute OD pain and decreased visual acuity presented with anterior uveitis, an intraocular pressure of 56 mm Hg, an open angle, ipsilateral nerve fiber bundle visual field defects, and optic nerve edema. With control of intraocular pressure and uveitis, visual acuity improved to 20/25, visual field defects persisted, and optic disc pallor developed. She has remained stable over 23 months of follow-up. This case represents a concurrence of glaucomatocyclitic crisis (Posner-Schlossman syndrome, PSS) and nonarteritic ischemic optic neuropathy (NAION). Although this combination occurs rarely, patients with PSS and other risk factors for NAION, including an optic disc that lacks a physiologic cup, should be protected against NAION by prophylactic treatment with ocular antihypertensive medications.