前床突磨除和视神经管开放对前床突脑膜瘤疗效的影响

Effect of anterior clinoid process osteotomy and optic canal opening on the treatment of anterior clinoid meningioma

目的探讨前床突(ACP)磨除和视神经管开放对前床突脑膜瘤(ACM)切除的影响,阐明ACP磨除和视神经管减压术的有效性和可行性。方法回顾性分析自1999年7月至2021年6月由笔者行手术治疗的63例ACM患者的临床资料,其中13例经硬膜外ACP磨除、视神经管去顶术,以及视鞘开口;36例经标准的额颞部开颅手术,其中6例术中硬膜内ACP磨除和开放视神经;14例经硬膜内外联合入路切除肿瘤。分析手术方式对肿瘤切除程度、视力功能恢复的影响,以及硬膜外与硬膜内ACP磨除术的疗效比较。结果术后3个月复查MRI结果显示,Simpson Ⅰ~Ⅱ级全切除48例(76.2%),Simpson Ⅲ~Ⅳ切除15例(23.8%)。肿瘤切除程度与是否实施ACP磨除、视神经管开放有关(P<0.05),而与手术方式(硬膜内、硬膜外或硬膜内外联合)无明显关系(P>0.05)。术后视力水平与术中视神经管开放有关(P<0.05),而与术中ACP是否磨除、手术方式无关(P>0.05)。结论磨除ACP和打开视神经管可以提高肿瘤全切除率,改善患者术后视力。

Objective To investigate the effects of anterior clinoid process(ACP)grinding and optic canal opening on the resection of anterior clinoid meningioma(ACM),and to clarify the benefits and feasibility of anterior clinoid process grinding and optic canal decompression.Methods The clinical data of 63 cases with ACM who were surgically treated by the author from July 1999 to June 2021 were analyzed retrospectively,including 13 cases of epidural ACP grinding,optic canal roof removal and optic sheath opening;36 cases underwent standard frontotemporal craniotomy,of which 6 cases underwent intradural ACP grinding and opening of the optic nerve;Tumors were resected through combined epidural and intradural approach in 14 cases.The effects of surgical methods on tumor resection and visual function recovery were analyzed,and the curative effects of epidural and intradural ACP grinding were compared.Results After 3 months of follow-up,the results of MRI showed that:Simpson grade Ⅰ-Ⅱ total resection was performed in 48 cases(76.2%),Simpson Ⅲ-Ⅳ resection in 15 cases(23.8%).The degree of tumor resection was related to whether anterior clinoid grinding and optic canal opening were performed(P<0.05),but there was no obvious relationship with the surgical methods(intradural,extradural,or combination of intradural and extradural)(P>0.05).The postoperative visual acuity level was related to the intraoperative opening of the optic canal(P<0.05),but it has nothing to do with whether ACP was removed or the surgical method(P>0.05).Conclusion ACP resection and optic canal opening can improve the rate of total tumor resection,and improve postoperative vision of patients.