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首页> 外文期刊>Neurosurgical focus >Tuberculum sellae meningiomas: grading scale to assess surgical outcomes using the transcranial versus transsphenoidal approach
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Tuberculum sellae meningiomas: grading scale to assess surgical outcomes using the transcranial versus transsphenoidal approach

机译：蝶鞍脑膜瘤：使用颅骨与经蝶窦入路评估手术结果的分级量表

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OBJECTIVE Tuberculum sellae meningiomas (TSMs) are surgically challenging tumors that can severely impair vision. Debate exists regarding whether the transcranial (TC) or endoscopic transsphenoidal (TS) approach is best for resecting these tumors, and there are few large series comparing these approaches. METHODS A retrospective chart review was performed at 2 academic centers comparing TC and TS approaches with respect to vision, extent of resection, recurrence, and complications. The authors report surgical outcomes and propose a simple preoperative tumor grading scale that scores tumor size (1–2), optic canal invasion (0–2), and arterial encasement (0–2). The authors performed univariate, multivariate, and recursive partitioning analysis (RPA) to evaluate outcomes. RESULTS The TSMs were resected in 139 patients. The median follow-up was 29 months. Ninety-five (68%) cases were resected via a TC and 44 (32%) via a TS approach. Tumors treated via a TC approach had a higher tumor (p = 0.0007), artery (p < 0.0001), and total score (p = 0.0012) on the grading scale. Preoperative visual deficits were present in 87% of patients. Vision improved in 47%, stayed the same in 35%, declined in 10%, and was not recorded in 8%. The extent of resection was 65% gross-total resection, 23% near-total resection (95%–99% resection), and 12% subtotal resection (< 95%). A lower tumor score was significantly associated with better or stable vision postoperatively (p = 0.0052). The RPA confirmed low tumor score as the key predictor of postoperative visual improvement or stability. Multivariate analysis and RPA demonstrate that lower canal score (p < 0.0001) and TC approach (p = 0.0019) are associated with gross-total resection. Complications occurred in 20 (14%) patients, including CSF leak (5%) and infection (4%). There was no difference in overall complication rates between TC and TS approaches; however, the TS approach had more CSF leaks (OR 5.96, 95% CI 1.10–32.04). The observed recurrence rate was 10%, and there was no difference between the TC and TS approaches. CONCLUSIONS Tuberculum sellae meningiomas can be resected using either a TC or TS approach, with low morbidity and good visual outcomes in appropriately selected patients. The simple proposed grading scale provides a standard preoperative method to evaluate TSMs and can serve as a starting point for selection of the surgical approach. Higher scores were associated with worsened visual outcomes and subtotal resection, regardless of approach. The authors plan a multicenter review of this grading scale to further evaluate its utility.
机译：目的蝶鞍脑膜瘤（TSMs）是外科手术中具有挑战性的肿瘤，可能严重损害视力。关于经颅（TC）或内镜经蝶窦（TS）的方法最适合切除这些肿瘤，存在争论，并且很少有比较这些方法的大系列文献。方法在2个学术中心进行回顾性图表审查，比较TC和TS方法的视野，切除范围，复发和并发症。作者报告了手术结果，并提出了一个简单的术前肿瘤分级量表，对肿瘤的大小（1-2），视神经管侵犯（0-2）和动脉包扎（0-2）进行评分。作者进行了单变量，多变量和递归分区分析（RPA）来评估结果。结果139例患者切除了TSM。中位随访时间为29个月。 TC切除了95例（68％），TS切除了44例（32％）。通过TC方法治疗的肿瘤在分级量表上具有较高的肿瘤（p = 0.0007），动脉（p <0.0001）和总分（p = 0.0012）。术前视力缺陷存在于87％的患者中。视力提高了47％，保持不变的是35％，下降了10％，没有记录到8％。切除范围为全切除65％，近全切除23％（95％–99％切除）和全切除12％（<95％）。较低的肿瘤评分与术后更好或稳定的视力显着相关（p = 0.0052）。 RPA证实低肿瘤评分是术后视力改善或稳定的关键预测指标。多变量分析和RPA证实，较低的根管评分（p <0.0001）和TC方法（p = 0.0019）与总切除量相关。 20例（14％）患者发生并发症，包括脑脊液漏（5％）和感染（4％）。 TC和TS方法的总并发症发生率没有差异。然而，TS方法有更多的CSF泄漏（OR 5.96，95％CI 1.10–32.04）。观察到的复发率为10％，TC和TS方法之间没有差异。结论鞍结节脑膜瘤可以使用一个TC或TS方法被切除，在适当选择的患者低发病率和良好的视觉效果。简单提出的分级量表为评估TSM提供了一种标准的术前方法，并且可以作为选择手术方法的起点。无论采用哪种方法，评分较高均与视力恶化和次全切除有关。作者计划对该分级表进行多中心审查，以进一步评估其效用。

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