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Vol. 21, Art. 91 (pp. 1178-1186)    |    2020       

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Optic nerve decompression in the structure of surgical treatment of parasellar meningiomas

North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russia, St. Petersburg
Bekhtereva Institute of Human Brain, the Russian Academy of Sciences, St. Petersburg
Almazov National Medical Research Centre, St. Petersburg, St. Petersburg

Brief summary

The term «parasellar meningiomas» was first used by Cushing and Eisenhardt in 1929 to describe meningiomas whose initial growth was the dura mater in the region of the sella turcica. Currently, the term includes such tumors as: meningiomas of the tubercle of the sella turcica, cavernous sinus, and anterior clinoid. The present study is based on a retrospective analysis of the results of surgical treatment of 112 patients with parasellar meningiomas who were examined and treated from January 2014 to November 2020 in Almazov National Medical Research Centre and Bekhtereva Institute of Human Brain, the Russian Academy of Sciences. The age of the patients was 28-65 years, mean age of all patients was 48.3 ?6. Pree Nimmannitya 2016 classification was used to divide the tumors based on the topographic and anatomical variant of their spread into the optic nerve canal. Analysis of the dynamics of visual functions in the early postoperative period showed that 6 (5.4%) patients with variants 3-SM, 3-IM, 4 according to P. Nimmannitya classification had worsening of visual functions, with 2 (1.8%) before amaurosis. Bone resection of the optic nerve canal was not performed in all of these patients in any of the possible technological variants. Thus, the frequency of visual function deterioration in this group was 30% (8 patients). Improvement was noted only in 20% of patients, usually with type 3-IM. In the remaining cases it was possible to stabilize visual functions at the preoperative level. None of 28 patients operated on using bone resection of the optic nerve canal had gross visual impairment. Extensive decompression of the optic nerve, by resection of the bony walls of its canal, and dissection of the crescentic ligament can significantly improve the results of surgical treatment, with regard to visual function, thereby providing a better quality of life. This task requires separate surgical attention, necessitating the use of non-trivial high-tech procedures. The use of blood-filled flaps for plasty of the skull base defect makes it possible to achieve convincing, reliable liquorostasis in the postoperative period.


Key words

parasellar meningioma, optic nerve, decompression.

Reference list

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