前床突脑膜瘤早期硬膜外磨除前床突对视神经的保护作用

Protection for optic nerve of early-stage extradural anterior micro-clinoidectomy for anterior clinoid process meningioma

目的探讨前床突脑膜瘤术中早期显微硬膜外磨除前床突的方法、禁忌证及其对视神经保护的解剖学依据。方法回顾性分析南京大学医学院附属鼓楼医院神经外科自2016年3月至2019年2月收治的16例前床突脑膜瘤患者的临床基本资料、手术方法及手术前后视力的恢复情况。16例患者术前均以视力下降为最明显症状,视力水平:光感3例、眼前手动2例、眼前指数3例、0.12例、0.23例、0.42例、0.51例。结果本组患者中SimpsonⅡ级切除12例,Ⅲ级切除4例;平均随访15个月,无死亡及新生症状,术前3例光感者、1例眼前手动者术后视力水平无变化,其余患者术后视力水平均有改善,无视力恶化者。结论前床突脑膜瘤患者术前视力普遍受损,术中早期显微硬膜外磨除前床突对术中视神经保护和术后视力恢复有积极作用。

Objective To discuss the methods and contraindications of extradural anterior micro-clinoidectomy during operation of anterior clinoid process meningioma and its experimental basis and anatomical basis of protection for optic nerve.Methods Visual acuity recovery of 16 consecutive cases of anterior bedside meningioma with visual impairment before operation,admitted to Neurosurgery Department of Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from March 2016 to February 2019,were analyzed retrospectively.Before operation,decrease of visual acuity was the commonest complain in all 16 cases.Visual acuity level:light-sense in 3 cases,hand-movement in 2 cases,finger-count in 3 cases and 0.1 in 2 cases,0.2 in 3 cases,0.4 in 2 cases,0.5 in 1 case.Results Simpson GradeⅡresection was achieved in 12 cases,GradeⅢresection in 4 cases.The average follow-up was 15 months.There was no death in this group,there was no change in visual acuity level in 4 cases:3 cases of light-sense,1 case of hand-movement,and the visual acuity level of the other patients was improved.Conclusion For patients with anterior clinoid process meningioma,the early-stage extradural anterior micro-clinoidectomy has a positive effect on the protection and recovery of vision.