거대 상상돌기 수막종에서의 미세수술 전략 (Microsurgical Strategy For Giant Clinoidal Meningiomas)

서지정보

· 발행기관 : 대한두개저학회
· 수록지 정보 : 대한두개저학회지 / 11권 / 2호 / 32 ~ 38페이지
· 저자명 : 송정원, 홍제범, 오성한, 김한규

초록

Background : The giant clinoidal meningiomas (CLMs) inevitably engulf the neurovascular structures around the anterior clinoid process (ACP), which make the surgery in great danger of internal carotid artery (ICA) compromise, neuroendocrine disturbance, blindness and oculomotor nerve palsy. The aim of this study was to suggest the safe surgical strategy for these dreadful tumors.
Materials and Methods : From March 2008 to April 2016, 12 patients underwent surgical removal for their giant CLMs. The clinical profile, radiological imaging, surgical records including surgical videos and postoperative neurologic outcomes were reviewed.
Results : The mean age of patients was 51.9 years. Average size of the tumors was 6.3 cm ranging from 5.0 cm to 8.3 cm. Surgery was performed in supine position and head was rotated about 45°to the contralateral side. The extradural anterior clinoidectomy was applied with extended pterional craniotomy including zygomatic osteotomy or orbitozygomatic osteotomy. We removed the tumor with the concept of compartment dissection in which we divided the tumor into medial and lateral compartment with the reference of ICA-M1 (sphenoidal segment of middle cerebral artery) line. Total tumor removal was achieved in 8 patients (67%) and subtotal in 4 patients (33%). Postoperative complications were transient oculomotor nerve palsy in 3 patients and decreased visual acuity in one patient. The mean preoperative Karnofsky Performance Scale (KPS) score was 82.5 (range 60-90) and improved to 95.8 (range 80-100) in the last follow up period.
Conclusion : The surgery of giant clinoidal meningiomas is difficult because of their giant size and multiple neurovascular and cisternal involvement. The most important factor for successful surgery is a three dimensional orientation of tumor with its surroundings. The concept of compartment issection would help surgeons to be oriented in perception of neurovascular structure surrounding the tumor. The extended pterional craniotomy, extradural anterior clinoidectomy, extended durotomy, and compartmental dissection are recommended for the efficient removal of these dreadful tumors.

영어초록

Background : The giant clinoidal meningiomas (CLMs) inevitably engulf the neurovascular structures around the anterior clinoid process (ACP), which make the surgery in great danger of internal carotid artery (ICA) compromise, neuroendocrine disturbance, blindness and oculomotor nerve palsy. The aim of this study was to suggest the safe surgical strategy for these dreadful tumors.
Materials and Methods : From March 2008 to April 2016, 12 patients underwent surgical removal for their giant CLMs. The clinical profile, radiological imaging, surgical records including surgical videos and postoperative neurologic outcomes were reviewed.
Results : The mean age of patients was 51.9 years. Average size of the tumors was 6.3 cm ranging from 5.0 cm to 8.3 cm. Surgery was performed in supine position and head was rotated about 45°to the contralateral side. The extradural anterior clinoidectomy was applied with extended pterional craniotomy including zygomatic osteotomy or orbitozygomatic osteotomy. We removed the tumor with the concept of compartment dissection in which we divided the tumor into medial and lateral compartment with the reference of ICA-M1 (sphenoidal segment of middle cerebral artery) line. Total tumor removal was achieved in 8 patients (67%) and subtotal in 4 patients (33%). Postoperative complications were transient oculomotor nerve palsy in 3 patients and decreased visual acuity in one patient. The mean preoperative Karnofsky Performance Scale (KPS) score was 82.5 (range 60-90) and improved to 95.8 (range 80-100) in the last follow up period.
Conclusion : The surgery of giant clinoidal meningiomas is difficult because of their giant size and multiple neurovascular and cisternal involvement. The most important factor for successful surgery is a three dimensional orientation of tumor with its surroundings. The concept of compartment issection would help surgeons to be oriented in perception of neurovascular structure surrounding the tumor. The extended pterional craniotomy, extradural anterior clinoidectomy, extended durotomy, and compartmental dissection are recommended for the efficient removal of these dreadful tumors.

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