Abstract
The study objective is evaluate the effectiveness and risks of using intradural and extradural decompression of the optic nerve channels during standard transcranial removal of meningiomas of the chiasmal-cellar region region. Materials and methods. The results of 161 decompression of channel of optic nerve in 129 patients are analyzed. In most patients (n = 122), an intradural decompression (resection) of the canal roof was performed. In 7 patients, an extradural decompression of the upper and lateral walls of the canal was performed. Results. In assessing the risks of visual impairment as a result of channel decompression, we found that decompression itself, without attempts to separate the tumor from the nerve, causes vision impairment in 8.6 % of cases. Attempts to separate the tumor from the optic nerves increase the risk of vision impairment from 16.7 to 26.9 %, depending on the radicality. Conclusion. A small number of complications (iatrogenic amaurosis and nasal liquorrhea) make it possible to recommend the described technique as an effective and safe addition to standard transcranial operations to remove the meningiomas of the chiasmal-cellar region.
Highlights
Цель исследования – определить эффективность и безопасность интрадуральной и экстрадуральной декомпрессии канала зрительного нерва в ходе стандартной транскраниальной операции по удалению менингиомы хиазмально-селлярной области
In assessing the risks of visual impairment as a result of channel decompression, we found that decompression itself, without attempts to separate the tumor from the nerve, causes vision impairment in 8.6 % of cases
Attempts to separate the tumor from the optic nerves increase the risk of vision impairment from 16.7 to 26.9 %, depending on the radicality
Summary
ТРАНСКРАНИАЛЬНАЯ ДЕКОМПРЕССИЯ КАНАЛОВ ЗРИТЕЛЬНЫХ НЕРВОВ ПРИ МЕНИНГИОМАХ ХИАЗМАЛЬНО-СЕЛЛЯРНОЙ ОБЛАСТИ: ЭФФЕКТИВНОСТЬ, РИСКИ И ОСЛОЖНЕНИЯ. Цель исследования – определить эффективность и безопасность интрадуральной и экстрадуральной декомпрессии канала зрительного нерва в ходе стандартной транскраниальной операции по удалению менингиомы хиазмально-селлярной области. Проанализированы результаты 161 декомпрессии канала зрительного нерва у 129 пациентов. Оценивая риски ухудшения зрения в результате декомпрессии канала, мы установили, что сама декомпрессия без попыток отделения опухоли от нерва вызывает ухудшение зрения в 8,6 % случаев. Ключевые слова: зрительный нерв, канал зрительного нерва, менингиома, основание черепа, хиазмально-селлярная область, декомпрессия, риски. Транскраниальная декомпрессия каналов зрительных нервов при менингиомах хиазмально-селлярной области: эффективность, риски и осложнения. Transcranial decompression of the optic nerve channels in meningiomas of the chiasmal-cellar region: efficiency, risks and complications. The study objective is evaluate the effectiveness and risks of using intradural and extradural decompression of the optic nerve channels during standard transcranial removal of meningiomas of the chiasmal-cellar region region. In 7 patients, an extradural decompression of the upper and la teral walls of the canal was performed
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