鞍结节脑膜瘤的临床特征

Clinical characteristics of tuberculum sellae meningiomas

目的探讨鞍结节脑膜瘤(TSM)的临床和影像学特点,以改善手术疗效。方法回顾性分析自2000年1月至2018年12月由笔者进行显微手术的156例TSM患者的临床资料,包括手术记录、出院记录、随访记录等,测量术前视力、视野及术后改善情况。根据CT和MRI的表现,将其分为巨大、大、中、小四型,分析讨论TSM临床和影像学特征。结果TSM最常见的症状是非对称性视觉障碍,本组术前视力<1.0者,占96.8%,非对称性视力障碍占84.1%;62.2%的肿瘤侵入视神经管内。术前有302只眼视力<1.0,占96.8%,术后218只眼(69.87%)视力改善,64只眼(20.51%)维持术前水平,30只眼(9.62%)恶化。术前73例患者(46.8%)的影像提示视神经管受累,术中探查共有97例视神经管内有肿瘤侵袭(62.2%,97/156)。患者的临床症状持续时间从1个月~5.3年(中位数21个月)。术后视力改善共218只眼(69.87%),64只眼(20.51%)维持术前水平,30只眼(9.62%)恶化。本组患者随访3个月~7.4年,肿瘤的切除程度SimpsonⅠ~Ⅱ145例,其中视力改善101例(69.66%);SimpsonⅢ~Ⅳ11例,其中视力改善8例(72.73%)。结论不对称性视觉功能障碍是TSM最早期,也是最常见的症状。肿瘤往往累及视神经管,这也是TSM术前评估的重点。

Objective To investigate the clinical and imaging features of tuberculum sellae meningioma(TSM)in order to improve the surgical effect.Methods The clinical data of 156 patients diagnosed with TSM who underwent microsurgery from January 2000 to December 2018 were analyzed retrospectively,including operation records,discharge records,follow-up records,preoperative visual acuity,visual field and postoperative improvement.According to the manifestations of CT and MRI,they were divided into giant,large,medium and small types,and the clinical and imaging features of TSM were analyzed and discussed.Results The most common symptom of TSM is asymmetric visual impairment.In this group,the preoperative visual acuity was less than 1.0,accounting for 96.8%,and asymmetric visual impairment accounted for 84.1%.62.2%of the tumors invaded the optic canal.Before operation,the vision of 302 eyes was lower than 1.0,accounting for 96.8%.After operation,the vision of218 eyes(69.87%)improved,64 eyes(20.51%)maintained the preoperative level,and 30 eyes(9.62%)deteriorated.The images of 73 patients before operation indicated that the optic canal was involved(46.8%).During the operation,there were 97 cases of tumor invasion in the optic canal(62.2%).The image of 73 patients before operation showed that the optic canal was involved(46.8%),and there were97 cases of tumor invasion in the optic canal(62.2%).The duration of clinical symptoms ranged from 1 month to 5.3 years(median 21 months).Postoperative vision improved in 218 eyes(69.87%),64 eyes(20.51%)maintained preoperative level,and 30 eyes(9.62%)deteriorated.The patients were followed up from 3 months to 7.4 years.The degree of tumor resection was SimpsonⅠ-Ⅱin 145 cases,vision improved in 101 cases(69.66%),Simpson Ⅲ-Ⅳ in 11 cases,vision improved in 8 cases(72.73%).Conclusion Asymmetric visual dysfunction is the earliest and most common symptom of TSM.Tumors often involve the optic canal,which is the focus of preoperative evaluation of TSM.