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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2023, Vol. 09 ›› Issue (03) : 142 -148. doi: 10.3877/cma.j.issn.2095-9141.2023.03.003

临床研究

前床突磨除和视神经管开放对前床突脑膜瘤疗效的影响
陈立华, 夏勇, 黄宏志, 魏帆, 孙恺, 陈文锦, 徐如祥†()   
  1. 610072　成都，电子科技大学附属医院·四川省人民医院神经外科
  • 收稿日期:2022-06-05 出版日期:2023-06-15
  • 通信作者: 徐如祥

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

Lihua Chen, Yong Xia, Hongzhi Huang, Fan Wei, Kai Sun, Wenjin Chen, Ruxiang Xu†()   

  1. Department of Neurosurgery, Affiliated Hospital of University of Electronic Science and Technology/Sichuan Provincial People's Hospital, Chengdu 610072, China
  • Received:2022-06-05 Published:2023-06-15
  • Corresponding author: Ruxiang Xu
  • Supported by:
    Key R&D Project of Sichuan Provincial Department of Science and Technology(2021YFS0010)
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陈立华, 夏勇, 黄宏志, 魏帆, 孙恺, 陈文锦, 徐如祥. 前床突磨除和视神经管开放对前床突脑膜瘤疗效的影响[J]. 中华神经创伤外科电子杂志, 2023, 09(03): 142-148.

Lihua Chen, Yong Xia, Hongzhi Huang, Fan Wei, Kai Sun, Wenjin Chen, Ruxiang Xu. Effect of anterior clinoid process osteotomy and optic canal opening on the treatment of anterior clinoid meningioma[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(03): 142-148.

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。

关键词: 前床突脑膜瘤, 前床突切除, 视神经管减压, 视觉功能, 肿瘤全切除率
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.

Key words: Anterior clinoid meningioma, Anterior clinoid process resection, Optic canal decompression, Visual function, Total tumor resection rate
图1 前床突脑膜瘤患者术前影像学资料A：CT平扫见肿瘤以前床突为中心的高密度灶，前床突骨质明显增生；B：增强冠状位像示肿瘤的基底在前床突尖，大小为4.9 cm×4.0 cm×3.3 cm；C：增强矢状位像示肿瘤周围有脑膜尾征；D：DSA侧位像示肿瘤有明显染色，眼动脉增粗参与肿瘤供血，床突上段颈内动脉受压向下移位，A1段被拉直变细
Fig.1 Preoperative imaging data of patients with anterior clinoid meningioma
图2 硬膜内入路切除肿瘤A：从前床突上离断肿瘤基底，阻断肿瘤血供；B：磨除前床突，打开视神经管，分离视神经管内的肿瘤；C：将视神经管内的肿瘤和床突段包绕颈内动脉的肿瘤一并分离切除
Fig.2 Intradural approach for tumor resection
图3 肿瘤全切除患者术后复查的影像学资料A：CT骨窗位冠状位像显示前床突磨除满意；B：MRI增强轴位像；C：增强冠状位像；D：增强矢状位像，提示肿瘤全切除
Fig.3 Imaging data of postoperative follow-up in patients with total tumor resection
表1 肿瘤切除程度与前床突磨除、视神经管开放的关系[例(%)]
Tab.1 Relationship between the degree of tumor resection and anterior clinoid process removal and optic canal opening [n(%)]
影响因素 Ⅰ~Ⅱ级切除（n=48） Ⅲ~Ⅳ级切除（n=15） χ2值 P值
视神经管     4.037 0.045
开放 20（41.67） 2（13.33）    
未开放 28（58.33） 13（86.67）    
前床突磨除     5.219 0.022
有 29（60.41） 4（26.67）    
无 19（39.59） 11（73.33）    
手术方式     0.076 0.963
硬膜外 10（20.83） 3（20.00）    
硬膜内 27（56.25） 9（60.00）    
硬膜内外 11（22.92） 3（20.00）    
表2 视觉功能恢复与视神经管开放、前床突磨除的关系
Tab.2 Relationship between visual function recovery and optic canal opening, anterior clinoid process grinding
影响因素 改善（n=48） 稳定（n=10） 恶化（n=5） Exp（B） P值
视神经管       9.987 0.033
开放 21 1 0    
未开放 27 9 5    
前床突磨除       1.909 0.280
有 26 5 1    
无 22 5 4    
手术方式       1.458 0.408
硬膜外 10 2 1    
硬膜内 29 5 2    
硬膜内外 9 3 2    
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