前床突脑膜瘤术后视力的影响因素研究

doi:10.3877/cma.j.issn.2095-123X.2022.06.003

目的

探讨前床突脑膜瘤（ACMs）术后视力恢复的影响因素。

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ACMs患者的临床资料，包括视觉功能和影像学特点、手术记录以及术后视觉随访结果，评估肿瘤的切除程度，分析影响患者术后视觉功能的因素。

结果

本组患者中Simpson I~Ⅱ级全切除48例（76.2%），Simpson Ⅲ~Ⅳ切除15例（23.8%）；术后视力总体改善率、稳定率和恶化率分别为76.2%（48/63）、15.9%（10/63）、7.9%（5/63）。术后永久性并发症4例，其中视力恶化2例，新发偏瘫1例，部分性动眼神经麻痹1例。无死亡病例。单因素分析结果表明，术前视力水平、肿瘤分型、术中是否开放视神经管是术后视觉功能的影响因素（P<0.05）。

结论

术前评估视力水平、肿瘤类型有助于预测ACMs患者术后的视觉功能水平，术中恰当选择开放视神经管的适应证有助于提高术后视力改善率。

关键词: 前床突脑膜瘤, 显微外科手术, 视神经管开放, 视神经减压, 视觉功能

Objective

To investigate the influencing factors of visual acuity recovery after anterior clinoid meningiomas (ACMs) surgery.

Methods

The clinical data of 63 patients with ACMs who were operated on by the authors from July 1999 to June 2021 were analyzed retrospectively, including visual function and imaging characteristics, surgical records and postoperative visual follow-up results. The degree of tumor resection was evaluated, and the factors affecting the postoperative visual function were analyzed.

Results

In this group, 48 patients (76.2%) underwent Simpson Ⅰ-Ⅱ total resection, and 15 patients (23.8%) underwent Simpson Ⅲ-Ⅳ resection. The overall improvement rate, stability rate and deterioration rate of postoperative visual acuity were 76.2% (48/63), 15.9% (10/63) and 7.9% (5/63), respectively. The results of univariate analysis showed that preoperative visual acuity, tumor classification and whether the optic canal was opened during operation were the influencing factors of postoperative visual function (P<0.05). Postoperative permanent complications occurred in 4 cases, including 2 cases of vision deterioration, 1 case of new hemiplegia and 1 case of partial oculomotor nerve palsy. There were no deaths.

Conclusion

Preoperative evaluation of visual acuity and tumor type is helpful to predict the postoperative visual function level of ACMs patients. Proper selection of indications for opening the optic canal during operation is helpful to improve the postoperative visual acuity.

Key words: Anterior clinoid meningioma, Microsurgery, Open optic canal, Optic nerve decompression, Visual function

表1 影响术后视觉功能的单因素分析[例（%）]

因素		改善	稳定	恶化	χ²值	P值
视觉障碍持续时间					4.686	0.079
	≤6个月	21	2	0
	>6个月	27	8	5
术前视力水平					29.093	<0.001
	<0.1	1	3	3
	0.1~0.9	46	3	2
	>0.9	1	4	0
肿瘤类型					23.380	<0.001
	Ⅰ型	3	4	0
	Ⅱ型	35	3	1
	Ⅲ型	1	3	1
	Ⅳ型	9	0	3
视神经管开放					7.062	0.029
	是	21	1	0
	无	27	9	5
前床突磨除					2.118	0.347
	有	26	5	1
	无	22	5	4
手术方式					1.684	0.794
	A组	10	2	1
	B组	29	5	2
	C组	9	3	2
肿瘤大小					10.557	0.053
	小型	3	2	0
	中型	20	3	1
	大型	23	2	3
	巨大型	2	3	1
视神经管受累					0.468	0.903
	有	16	4	2
	无	32	6	3

表1 影响术后视觉功能的单因素分析[例（%）]

因素		改善	稳定	恶化	χ²值	P值
视觉障碍持续时间					4.686	0.079
	≤6个月	21	2	0
	>6个月	27	8	5
术前视力水平					29.093	<0.001
	<0.1	1	3	3
	0.1~0.9	46	3	2
	>0.9	1	4	0
肿瘤类型					23.380	<0.001
	Ⅰ型	3	4	0
	Ⅱ型	35	3	1
	Ⅲ型	1	3	1
	Ⅳ型	9	0	3
视神经管开放					7.062	0.029
	是	21	1	0
	无	27	9	5
前床突磨除					2.118	0.347
	有	26	5	1
	无	22	5	4
手术方式					1.684	0.794
	A组	10	2	1
	B组	29	5	2
	C组	9	3	2
肿瘤大小					10.557	0.053
	小型	3	2	0
	中型	20	3	1
	大型	23	2	3
	巨大型	2	3	1
视神经管受累					0.468	0.903
	有	16	4	2
	无	32	6	3

[1]	Pamir MN, Belirgen M, Ozduman K, et al. Anterior clinoidal meningiomas: Analysis of 43 consecutive surgically treated cases[J]. Acta Neurochir (Wien), 2008, 150(7): 625-635.
[2]	Xu T, Yan Y, Evins AI, et al. Anterior clinoidal meningiomas: meningeal anatomical considerations and surgical implications[J]. Front Oncol, 2020, 10: 634.
[3]	Kim JH, Jang WY, Jung TY, et al. Predictive factors for surgical outcome in anterior clinoidal meningiomas: analysis of 59 consecutive surgically treated cases[J]. Medicine (Baltimore), 2017, 96(15): e6594.
[4]	陈立华,夏勇,魏帆,等.前床突脑膜瘤术后并发症的分析与防治[J].中华脑科疾病与康复杂志(电子版), 2021, 11(3): 147-152.
[5]	Pamir MN, Özduman K. Clinoidal meningiomas[J]. Handb Clin Neurol, 2020, 170: 25-35.
[6]	Bassiouni H, Asgari S, Sandalcioglu IE, et al. Anterior clinoidal meningiomas: functional outcome after microsurgical resection in a consecutive series of 106 patients. Clinical article[J]. J Neurosurg, 2009, 111(5): 1078-1090.
[7]	Zhang Y, Kim J, Andrews C, et al. Visual outcomes in surgically treated intracranial meningiomas[J]. J Neuroophthalmol, 2021, 41(4): e548-e559.
[8]	Schick U, Hassler W. Surgical management of tuberculum sellae meningiomas: involvement of the optic canal and visual outcome[J]. J Neurol Neurosurg Psychiatry, 2005, 76(7): 977-983.
[9]	Sughrue M, Kane A, Rutkowski MJ, et al. Meningiomas of the anterior clinoid process: is it wise to drill out the optic canal?[J]. Cureus, 2015, 7(9): e321.
[10]	Mariniello G, de Divitiis O, Bonavolontà G, et al. Surgical unroofing of the optic canal and visual outcome in basal meningiomas[J]. Acta Neurochir (Wien), 2013, 155(1): 77-84.
[11]	Kutin MA, Kadashev BA, Kalinin PL, et al. Ttranscranial microsurgical decompression of the optic canal in surgical treatment of meningiomas of the sellar region[J]. Zh Vopr Neirokhir Im N N Burdenko, 2020, 84(3): 61-73.
[12]	Lefevre E, Terrier LM, Bekaert O, et al. Microsurgical transcranial approach of 112 paraoptic meningiomas: a single-center case series[J]. Oper Neurosurg (Hagerstown), 2020, 19(6): 651-658.
[13]	Mathiesen T, Kihlström L. Visual outcome of tuberculum sellae meningiomas after extradural optic nerve decompression[J]. Neurosurgery, 2006, 59(3): 570-576; discussion 570-576.
[14]	Salgado López L, Muñoz Hernández F, Asencio Cortés C, et al. Extradural anterior clinoidectomy in the management of parasellar meningiomas: analysis of 13 years of experience and literature review[J]. Neurocirugia (Astur: Engl Ed), 2018, 29(5): 225-232.
[15]	Nimmannitya P, Goto T, Terakawa Y, et al. Characteristic of optic canal invasion in 31 consecutive cases with tuberculum sellae meningioma[J]. Neurosurg Rev, 2016, 39(4): 691-697.
[16]	Lee JH, Sade B, Park BJ. A surgical technique for the removal of clinoidal meningiomas[J]. Neurosurgery, 2006, 59(1 Suppl 1): ONS108-114; discussion ONS108-114.
[17]	Kimura Y, Wanibuchi M, Akiyama Y, et al. Preserved arachnoid membrane acts as a predictor of postoperative visual improvement in clinoidal meningioma[J]. Clin Neurol Neurosurg, 2021, 208: 106874.
[18]	Attia M, Umansky F, Paldor I, et al. Giant anterior clinoidal meningiomas: surgical technique and outcomes[J]. J Neurosurg, 2012, 117(4): 654-665.

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Study on the factors influencing postoperative visual acuity of anterior clinoid meningioma

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Study on the factors influencing postoperative visual acuity of anterior clinoid meningioma