Abstract

The main purpose of surgery for tuberculum sellae meningioma (TSM) is the improvement and/or stabilization of patients’ visual function. Options for the side of lateral approaches usually were restricted for nondominant right-sided craniotomy or to the side of impaired vision (ipsilateral approaches). Although the safety and effectiveness of ipsilateral transcranial approach was proved, there are some doubts and discussions about the contralateral craniotomy. We retrospectively analyzed the series of contralateral surgeries of TMS and their visual outcomes comparing with ipsilateral approach. Twenty-six patients with TSM were operated on from 2010 to 2019 (F/M 20/6, mean age 49 years), in 17 (65%) we performed contralateral and in 9 (35%) ipsilateral approach. All procedures were performed via fronto-lateral craniotomy. Gross total resection (GTR) was achieved in 21 (81%) cases and in all but one patient we noticed visual improvement after surgery (96%). Optic canal unroofing with mobilization of more affected visual nerve was necessary in 5/9 pts of ipsilateral vs 3/17 pts of contralateral group. We had no significant postoperative complications.

There was no difference in outcome between ipsilateral and contralateral fronto-lateral approaches for TSM resection; thus, contralateral approach was at least as safe and effective as ipsilateral.

中文翻译：

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蝶鞍脑膜瘤手术：对侧入路的视觉效果和手术方面

摘要

蝶鞍脑膜瘤（TSM）手术的主要目的是改善和/或稳定患者的视觉功能。对于非优势的右侧颅骨切开术或视力障碍的一侧（同侧入路），通常选择外侧入路的选择。尽管已证明了同侧经颅入路的安全性和有效性，但对侧颅骨切开术仍存在一些疑问和讨论。我们回顾性分析了TMS的对侧手术系列及其与同侧手术方法相比的视觉效果。从2010年至2019年，对26例TSM患者进行了手术（F / M 20/6，平均年龄49岁），其中17例（65％）接受对侧手术，9例（35％）采用对侧手术。所有手术均通过额开颅手术进行。21例（81％）达到了总切除（GTR），除一名患者外，我们均注意到手术后的视力有所改善（96％）。同侧组的5/9分与对侧组的3/17分，需要动员更多受影响的视神经来进行视神经管根治术。我们没有明显的术后并发症。

TSM切除的同侧和对侧额外侧方法之间的结果无差异。因此，对侧入路至少与同侧同样安全有效。