Transcranial bony optic nerve decompression in surgical treatment of basal meningiomas
Keywords:meningioma, optic nerve, sellar (parasellar) localization, optochiasmatic localization, surgical treatment, optic nerve decompression, anterior clinoidectomy
Background. Surgical treatment of basal meningioma has always been recognized as an important problem of neurosurgery. Tumor extension to the optic canal is considered to be the main factor limiting the radical removal of these tumors, on the one hand, and defining unsatisfactory functional results of surgical interventions, on the other hand. Therefore in current literature the key to the surgery of suprasellar meningioma extending into optic canal is the early extradural decompression of the optic nerve, its maximum mobilization before direct manipulation of the tumor. Large surgical series prove that this approach provides the basis for meningioma radical excision with preserving or improving impaired optical functions.
Aim. To improve treatment results in patients with basal meningiomas, which involve the optic canal and lead to visual deterioration.
Materials and methods. This study includes various optic nerve decompression (OND), with maximum optic canal decompression added by anterior clinoidectomy. The paper studies the question of rational of optic nerve decompression, its volume and technique. The paper analyzes the results of surgical treatment of 85 basal meningiomas in the sellar and parasellar region, which involved the optic canal and treated by BOND in different variantions. Males were 30 (35.3%), female 55 (64.7%). The average age was 54.6 ± 5.3 years. By the surgical intervention method the patients were divided into two clinical subgroups. The first subgroup consisted of patients with bony optic canal decompression (39 patients(45.9%)), the second subgroup included those without such manipulations (46 cases (54.1%)).
Results and discussion. The results of surgical treatment for visual functions were statistically significantly better in the subgroup of the patients undergone bony canal decompression. The choice of approach to the tumors in both groups was predetermined rather by topographic and anatomical peculiarities and meningioma size than the necessity of optic nerve decompression.
Conclusion. Optic canal decompression is an important step providing a good functional result of surgical treatment of the patient with supra and parasellar meningiomas.
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Copyright (c) 2017 Zinovii M. Nykyforak, Arthur O. Mumliev, Mykola O. Guk, Мichail S. Kvasha, Vasyl V. Kondratiuk, Valentyn M. Kliuchka
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