Ricardo Marian-Magaña , Marcos V. Sangrador-Deitos , Luis Rodríguez-Hernández , Jorge A. Lara-Olivas , Germán López-Valencia , Rodolfo Villalobos-Díaz , Jorge F. Aragón-Arreola , Karen E. Padilla-Leal , Jesús Humberto García-Zazueta , Alfredo Camacho-Castro , Juan L. Gómez-Amador
{"title":"经颅法与内窥镜鼻内膜法比较蝶鞍结节脑膜瘤的视觉效果","authors":"Ricardo Marian-Magaña , Marcos V. Sangrador-Deitos , Luis Rodríguez-Hernández , Jorge A. Lara-Olivas , Germán López-Valencia , Rodolfo Villalobos-Díaz , Jorge F. Aragón-Arreola , Karen E. Padilla-Leal , Jesús Humberto García-Zazueta , Alfredo Camacho-Castro , Juan L. Gómez-Amador","doi":"10.1016/j.wnsx.2024.100319","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Tuberculum sellae meningiomas (TSM) account for 3–10% of intracranial meningiomas. Visual loss is the presenting symptom in up to 80% of cases. Surgical management poses a great challenge due to tumor proximity to neurovascular structures such as the optic nerve and the internal carotid artery (ICA); hence, there is controversy regarding the optimal approach. The aim of this study is to determine differences in visual outcomes between transcranial (TCA) and endoscopic endonasal (EEA) approaches.</p></div><div><h3>Methods</h3><p>A retrospective study including 29 patients with TSM surgically treated by TCA or EEA between 2011 and 2023 in a single referral center was conducted. Pre-and post-operative neuro-ophthalmologic evaluations, focusing on visual acuity and campimetry, were evaluated.</p></div><div><h3>Results</h3><p>Sixteen (55.16%) patients were intervened through a TCA and the remaining 13 (44.84%) via an EEA. The lesions in each group were similar in terms of pre- operative volume (15.12 vs 12.9 cm<sup>3</sup>, p = 0.497) and neurovascular invasion (optic canal invasion 48.26 vs 41.37%, p = 0.664; ICA 44.81 vs 31.03%, p = 0.797). There were no significant differences in visual outcomes between both approaches; TCA presented an improvement of 5.18 points in visual fields (p = 0.140), whereas EEA had an improvement of 17.39 points in visual acuity (p = 0.114).</p></div><div><h3>Conclusion</h3><p>EEA seems to offer greater improvement in visual acuity than TCA. However, the ideal approach should be individualized; taking into account the tumor’s volume and invasiveness, as well as the patient's visual complaints.</p></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"23 ","pages":"Article 100319"},"PeriodicalIF":0.0000,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590139724000504/pdfft?md5=db71a5992064d17df3acc152cb8d7208&pid=1-s2.0-S2590139724000504-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Visual outcomes in tuberculum sellae meningiomas comparing transcranial and endoscopic endonasal approaches\",\"authors\":\"Ricardo Marian-Magaña , Marcos V. Sangrador-Deitos , Luis Rodríguez-Hernández , Jorge A. Lara-Olivas , Germán López-Valencia , Rodolfo Villalobos-Díaz , Jorge F. Aragón-Arreola , Karen E. Padilla-Leal , Jesús Humberto García-Zazueta , Alfredo Camacho-Castro , Juan L. Gómez-Amador\",\"doi\":\"10.1016/j.wnsx.2024.100319\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Tuberculum sellae meningiomas (TSM) account for 3–10% of intracranial meningiomas. Visual loss is the presenting symptom in up to 80% of cases. Surgical management poses a great challenge due to tumor proximity to neurovascular structures such as the optic nerve and the internal carotid artery (ICA); hence, there is controversy regarding the optimal approach. The aim of this study is to determine differences in visual outcomes between transcranial (TCA) and endoscopic endonasal (EEA) approaches.</p></div><div><h3>Methods</h3><p>A retrospective study including 29 patients with TSM surgically treated by TCA or EEA between 2011 and 2023 in a single referral center was conducted. Pre-and post-operative neuro-ophthalmologic evaluations, focusing on visual acuity and campimetry, were evaluated.</p></div><div><h3>Results</h3><p>Sixteen (55.16%) patients were intervened through a TCA and the remaining 13 (44.84%) via an EEA. The lesions in each group were similar in terms of pre- operative volume (15.12 vs 12.9 cm<sup>3</sup>, p = 0.497) and neurovascular invasion (optic canal invasion 48.26 vs 41.37%, p = 0.664; ICA 44.81 vs 31.03%, p = 0.797). There were no significant differences in visual outcomes between both approaches; TCA presented an improvement of 5.18 points in visual fields (p = 0.140), whereas EEA had an improvement of 17.39 points in visual acuity (p = 0.114).</p></div><div><h3>Conclusion</h3><p>EEA seems to offer greater improvement in visual acuity than TCA. However, the ideal approach should be individualized; taking into account the tumor’s volume and invasiveness, as well as the patient's visual complaints.</p></div>\",\"PeriodicalId\":37134,\"journal\":{\"name\":\"World Neurosurgery: X\",\"volume\":\"23 \",\"pages\":\"Article 100319\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-03-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2590139724000504/pdfft?md5=db71a5992064d17df3acc152cb8d7208&pid=1-s2.0-S2590139724000504-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Neurosurgery: X\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2590139724000504\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Neurosurgery: X","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2590139724000504","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Medicine","Score":null,"Total":0}
Visual outcomes in tuberculum sellae meningiomas comparing transcranial and endoscopic endonasal approaches
Background
Tuberculum sellae meningiomas (TSM) account for 3–10% of intracranial meningiomas. Visual loss is the presenting symptom in up to 80% of cases. Surgical management poses a great challenge due to tumor proximity to neurovascular structures such as the optic nerve and the internal carotid artery (ICA); hence, there is controversy regarding the optimal approach. The aim of this study is to determine differences in visual outcomes between transcranial (TCA) and endoscopic endonasal (EEA) approaches.
Methods
A retrospective study including 29 patients with TSM surgically treated by TCA or EEA between 2011 and 2023 in a single referral center was conducted. Pre-and post-operative neuro-ophthalmologic evaluations, focusing on visual acuity and campimetry, were evaluated.
Results
Sixteen (55.16%) patients were intervened through a TCA and the remaining 13 (44.84%) via an EEA. The lesions in each group were similar in terms of pre- operative volume (15.12 vs 12.9 cm3, p = 0.497) and neurovascular invasion (optic canal invasion 48.26 vs 41.37%, p = 0.664; ICA 44.81 vs 31.03%, p = 0.797). There were no significant differences in visual outcomes between both approaches; TCA presented an improvement of 5.18 points in visual fields (p = 0.140), whereas EEA had an improvement of 17.39 points in visual acuity (p = 0.114).
Conclusion
EEA seems to offer greater improvement in visual acuity than TCA. However, the ideal approach should be individualized; taking into account the tumor’s volume and invasiveness, as well as the patient's visual complaints.
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