Endoscopic Endonasal Removal of Primary/Recurrent Meningiomas in the Medial Optic Canal: Surgical Technique and Long-Term Visual Outcome
| Autor: | Nobuyuki Takeshige, Naohisa Miyagi, Motohiro Morioka, Yui Nagata, Hidenobu Yoshitake, Satoru Komaki, Kiyohiko Sakata |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Natural Orifice Endoscopic Surgery medicine.medical_specialty genetic structures medicine.medical_treatment Vision Disorders Skull Base Neoplasms Meningioma Tuberculum Sellae Meningioma Postoperative Complications Sphenoid Bone Meningeal Neoplasms otorhinolaryngologic diseases medicine Humans Sella Turcica Craniotomy Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test Optic canal business.industry Progressive visual loss Optic Nerve Middle Aged medicine.disease eye diseases Tumor Burden Endoscopy Surgery Treatment Outcome medicine.anatomical_structure Optic Nerve Injuries Neuroendoscopy Optic nerve Tuberculum sellae Female sense organs Neurology (clinical) Nasal Cavity Neoplasm Recurrence Local business |
| Zdroj: | Operative Neurosurgery. 17:470-480 |
| ISSN: | 2332-4260 2332-4252 |
| Popis: | Background Tuberculum sellae meningiomas frequently extend into the optic canals, which leads to a progressive longitudinal visual loss. Therefore, in addition to tumor removal, unroofing and exploration inside the optic canal are important procedures. Objective To perform endoscopic endonasal tumor removal with optic canal decompression for small primary or recurrent meningiomas associated with a progressive visual loss at the inferior-medial optic canal, which corresponded to a blind corner in the ipsilateral pterional/subfrontal approach. Methods We retrospectively reviewed 2 cases of primary meningiomas that arose in the inferior-medial optic canal and 4 recurrent cases from the remnant inside the medial optic canal that had previously undergone craniotomy for tuberculum sellae meningiomas, and were treated by the endoscopic endonasal approach. Results All tumors were detectable and could be removed without manipulation of the affected optic nerve. The average maximum diameter of the tumor was 8.4 mm (range: 5-12 mm). Two patients who had a long history of progressive visual disturbance and papillary atrophy did not recover from severe visual disturbances postoperatively. However, others showed considerable improvement, maintaining postoperative visual function during follow-up. There were no postoperative complications. Conclusion Endoscopic endonasal approach has several advantages for meningiomas in the medial optic canal and associated with progressive visual disturbance. In surgery of tuberculum sellae meningiomas, optic canal decompression and exploration inside the optic canal are important procedures to avoid symptomatic recurrence, which may be facilitated by the endoscopic endonasal approach. Papillary atrophy and duration of visual deterioration are predictive factors for postoperative visual outcomes. |
| Databáze: | OpenAIRE |
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