影响鞍结节脑膜瘤手术治疗后视力改善的相关因素分析

Analysis of Correlation Factors for the Visual Outcome in Patients after Microsurgery for Tuberculum Sellae Meningioma

目的:鞍结节脑膜瘤常会因为压迫视神经导致视力丧失,手术治疗最重要目的是为了改善视力,视力恢复的程度也是衡量手术治疗效果的重要指标。本文重点分析显微外科手术治疗鞍结节脑膜瘤影响视力功能改善的相关因素。方法:回顾近10年来手术治疗的51例鞍结节脑膜瘤病例,这些患者均接受经翼点入路或经额下入路手术治疗。其中41例(80.4%)患者就诊时有视力障碍症状,男17例,女24例,平均42.4岁。症状中位持续时间为11个月。单眼视力障碍25例,双眼视力障碍16例,2例只有视野的缩小。通过MRI测量肿瘤的直径为0.6～5.4cm,无和轻度瘤周水肿26例,严重瘤周水肿15例。结果:手术全切率为80.4%。术前有视力障碍的术后30例(73.2%)改善,2例(4.9%)加重,9例(22%)无变化。术后其他并发症包括:尿崩症8例(均为术后一过性,术后1周内缓解),垂体功能低下2例,癫痫2例,下丘脑功能障碍1例,颅内感染1例。随访6～60个月。结论:标准的显微外科开颅术治疗鞍结节脑膜瘤,暴露充分,肿瘤全切率高且并发症少。分析发现以下因素不利于术后视力功能的改善:患者年龄大于60岁;视神经功能障碍超过1年;视神经功能障碍严重;瘤周水肿明显;肿瘤与脑组织间缺少明确的蛛网膜层面;肿瘤未能全切。

Objective： To explore the factors associated with visual outcome in patients after microsurgery for tuberculum sellae meningioma. Methods： The clinical data from 51 patients with tuberculum sellae meningioma who underwent surgery in our hospital between 1998 and 2007 were retrospectively analyzed. The clinical risk factors associated with postoperative visual outcome were evaluated by univariate analysis. Results： The complete resection rate was 80.4%. The vision was improved in 73.2% patients and worsened in 4.9% pa- tients. About 22% patients had no changes in vision. Other postoperative complications included diabetes inspidus in 8 patients （relieved in 1 week）, hypopituitaism in 2 patients, seizures in 2 patients, hypothalamus dysfunction in 1 patient, and intracranial infection in 1patient. The risk factors included age, duration of visual symptoms, presence of significant peri-tumoural edema, intactness of arachnoid plane and the rate of resection. Conclusion： A standard pterional craniotomy using microsurgical technique provides the necessary exposure and enables total removal, with minimum complications. Patient age of more than 60, duration of visual symptoms longer than 1 year, severe visual symptomatology, presence of significant peri-tumoural edema, absence of an intact arachnoid plane and total resection were correlated factors for impaired postoperative vision.