Artikel
Meningiomas involving the anterior optic system – clinical presentation and results of surgical treatment
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Autoren
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M. Nakamura
- Klinik für Neurochirurgie, Medizinische Hochschule Hannover
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J. Krauss
- Klinik für Neurochirurgie, Medizinische Hochschule Hannover
| Veröffentlicht: | 20. Mai 2009 |
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Gliederung
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Objective: Meningiomas involving the anterior visual system may originate from different anatomical sites of the anterior or middle fossa. The form of compression of the optic nerve or chiasm depends on the direction of tumor growth and site of tumor origin. We report on a series of 32 patients with 34 meningiomas, which were operated because of compression of the anterior visual system, present the surgical management and results with respect to the mode of visual impairment.
Methods: All patients were operated through the frontolateral or pterional approach using microsurgical technique between January 2006 and November 2008. Clinical data were collected prospectively including preoperative medical history, radiological, operative and histological findings, and follow up records.
Results: Our series includes 26 women and 6 men with a mean age of 53.8 years (35–77 years). There were 9 spheno-orbital, 6 planum sphenoidale, 6 tuberculum sellae, 4 olfactory groove, 4 supra/parasellar (with cavernous sinus infiltration), 2 medial sphenoid wing, 2 anterior clinoid meningiomas and 1 optic nerve sheath meningioma. Seven meningiomas presented as recurrent tumors. Surgical decompression of the optic nerve or chiasm was performed in all cases. Total tumor resection was achieved in 17 tumors, a subtotal resection in 11, and partial resection in 6 tumors. Intracanalicular tumor growth was observed during surgery in 8 cases. Opening of the optic canal was accomplished in 11 cases. In patients with preoperatively functional vision (n=26), visual function improved in 65.4%, remained stable in 30.8% and was worse in 3.8%. In 8 patients with preoperatively complete loss of vision, vision did not recover. There was 1 tumor with recurrent optic nerve compression 27 months after surgery. Five patients underwent postoperative stereotactic radiotherapy. The mean follow-up time was 20.9 months (4–33 months).
Conclusions: The majority of patients with anterior and middle skull base meningiomas compressing the optic nerve or chiasm benefit from surgical decompression except from those with preoperatively complete loss of vision. Best results were observed in patients with frontobasal or tuberculum sellae meningiomas, where decompression of the anterior optic system may lead to immediate visual improvement.
