关键词: 鞍结节脑膜瘤, 同侧入路, 对侧入路, 切除程度

Abstract: Objective To investigate the long-term visual and olfactory prognosis and recurrence rate of patients with tuberculum sellae meningioma(TSM) operated by the ipsilateral or contralateral transcranial approach.Methods Retrospective analysis was made on 44 patients with unilateral TSM who received surgical treatment in neurosurgery department of our hospital from March 2012 to April 2018.The ipsilateral or contralateral approach was selected according to the main compressed side of the optic nerve.The surgical outcome,visual acuity,visual field improvement and complications were evaluated.Results The visual acuity decreased in 40 cases before operation,recovered completely in 18 cases,improved in 10 cases,remained unchanged in 8 cases,and deteriorated further in 4 cases.Among 42 cases with visual field defect before operation,20 cases were completely recovered,12 cases were significantly improved,2 cases had stable visual field,and 4 cases had long-term visual impairment after operation.The contralateral approach was more conducive to the improvement of visual field defect in patients with TSM after surgery(OR=0.379,95% CI=0.125~0.954,P=0.038).However,the rate of olfactory nerve injury after contralateral approach was higher(45.0% vs.12.5%,P=0.016).94.4%(17/18) of patients with contralateral approach and 50.0%(6/12) of patients with ipsilateral approach achieved gross total resection of tumors invading the optic canal(P=0.005).During the follow-up period,5 cases(10.6%) recurred,all of them were Simpson Grade Ⅳ subtotal resection(including 2 WHO Grade Ⅱ).Conclusion Resection of TSM via contralateral approach seems to provide better visual field improvement rate and overall tumor resection rate,but increases the risk of olfactory nerve injury.

Key words: tuberculum sellae meningioma, ipsilateral approach, contralateral approach, degree of resection