Effect of early optic canal unroofing on the outcome of visual functions in surgery for meningiomas of the tuberculum sellae and planum sphenoidale.

摘要

OBJECTIVE: The aim of this study was to evaluate the effect of early optic canal unroofing on visual function in patients with meningiomas of the tuberculum sellae and planum sphenoidale. METHODS: We retrospectively reviewed the clinical records of 20 consecutive patients with tuberculum sellae meningiomas and two patients with planum sphenoidale meningiomas who were admitted to our institution from 1999 to 2007. Factors that may influence postoperative visual functions were analyzed, including patient's age and sex, duration of preoperative visual symptoms, preoperative visual acuity, tumor size, tumor consistency, tumor extension into the optic canal, tumor adhesion to the optic nerve, timing of optic canal unroofing, and tumor resection rate. RESULTS: The mean patient age was 52.9 +/- 13.7 years (range, 27-73 yr); 18 patients were women and four were men. The mean maximum tumor size was 2.3 +/- 0.7 cm (range, 1.5-3.5 cm). Visual symptoms were present preoperatively in 19 patients, and three patientswere asymptomatic. The mean duration of visual symptoms was 12.0 +/- 16.4 months (range, 0-72 mo). Tumor resection was evaluated according to Simpson's grade, and Grade II was achieved in 14, Grade III in two, and Grade IV in six (two patients were recurrent cases). Tumors were extended into the optic canal in 15 patients, and severe adhesion to the optic nerve was observed in nine patients. Tumor consistency was soft in eight patients, intermediate in eight patients, and hard in six patients. The optic canal was unroofed early before dissection or manipulation of tumor in nine patients (early group) and after dissection of tumor in seven patients (late group), and optic canal unroofing was not performed in six patients (none group; no canal extension in two and intentional incomplete resection in four patients). Visual symptoms were improved in 10 patients, unchanged in seven patients, and worsened in five patients (transient in two and permanent in three). Logistic regression analysis revealed that early optic canal unroofing was an independent factor for postoperative improvement of visual symptoms. CONCLUSION: Early optic canal unroofing may increase the possibility of improved preoperative visual symptoms in surgical resection of tuberculum sellae meningiomas and planum sphenoidale meningiomas.