Assessment of optic nerve decompression efficiency in resection of sellar region meningiomas via intradural subfrontal approach

Kutin M.A.; Kadashev B.A.; Kalinin P.L.; Serova N.K.; Tropinskaia O.F.; Andreev D.N.; Fomichev D.V.; Sharipov O.I.; Turkin A.M.; Shul'ts E.I.

doi:https://doi.org/

Kutin M.A.

NII neĭrokhirurgii im. N.N. Burdenko RAMN, Moskva

Kadashev B.A.

NII neĭrokhirurgii im. N.N. Burdenko RAMN, Moskva

Kalinin P.L.

NII neĭrokhirurgii im. N.N. Burdenko RAMN, Moskva

Serova N.K.

NII neĭrokhirurgii im. N.N. Burdenko RAMN, Moskva

Tropinskaia O.F.

NII neĭrokhirurgii im. N.N. Burdenko RAMN, Moskva

Andreev D.N.

GBOU VPO "Moskovskiĭ gosudarstvennyĭ mediko-stomatologicheskiĭ universitet im. A.I. Evdokimova" Minzdrava Rossii

Fomichev D.V.

Burdenko Neurosurgical Institute, Moscow, Russia

Sharipov O.I.

Burdenko Neurosurgical Institute, Moscow, Russian Federation

Turkin A.M.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Shul'ts E.I.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

SPIN RSCI: 3255-8587
Scopus AuthorID: 57112078200
ORCID: 0000-0001-5406-944X

Assessment of optic nerve decompression efficiency in resection of sellar region meningiomas via intradural subfrontal approach

Authors:

Kutin M.A., Kadashev B.A., Kalinin P.L., Serova N.K., Tropinskaia O.F., Andreev D.N., Fomichev D.V., Sharipov O.I., Turkin A.M., Shul'ts E.I.

More about the authors

Journal: Burdenko's Journal of Neurosurgery. 2014;78(4): 14‑30

Read: 2207 times

To cite this article:

Kutin MA, Kadashev BA, Kalinin PL, et al. . Assessment of optic nerve decompression efficiency in resection of sellar region meningiomas via intradural subfrontal approach. Burdenko's Journal of Neurosurgery. 2014;78(4):14‑30. (In Russ., In Engl.)

Подписка 2025 Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко (Burdenko's Journal of Neurosurgery)

Использование инфографики авторами научных работ

Close metadata

Abstract:

In this article we analyze results of the different variants of the optic nerve transcranial decompression in cases with different chiasmal region tumors. We operate 70 patient with different type meningioma (tuberculum sella, shenoid wings, anterior clinoid, optic canal), pituitary adenoma and one case with tuberculoma (we operate it thinking on meningioma, but histology was unexpected). Groups of the patients. Group1. 20 patients with pituitary adenoma with cavernous sinus invasion. It was our "pre-endoscopic" period when we frequently operated adenomas by transcranial approach. In this 20 patients we used intra-extradural Dolenc approach to cavernous sinus. In that cases we removed anterior clinoid process and decompressed optic canal. Here we use the results of surgery in this group for showing the possibility of using high speed drill for the optic canal decompression - for showing it safety. On our opinion this type of optic canal decompression is radical and safe but superfluous for the optic canal invasion by the meningioma. Group 2. 19 patients with meningioma. In that cases we partially unroofed optic canal by Kerrison and additionally we cut the falciform ligament. Group 3. 31 patients with meningioma. It's our "main" group. Here we made intradural wide unroofing the optic canal by high speed drill. Additionaly we cut the falciform ligament and open the dural sheet of the optic nerve. We propose this methodic like sufficient, safe and useful. In this cases we frequently saw the tumor spread inside the dural sheet of the optic nerve, without seeing it on the MRI. A lot of cases in this group was a recurrent after previous meningioma removal. Like a control groups we use two. Group 4. 11 cases with meningioma. In that cases we removed tumor from optic canal without any decompression. It was our archive group - we made this type of surgery before starting optic canal decompression. This group shows the risks of any manipulation with fixed optic nerves without optic canal decompression. Group 5. 31 case with meningioma. In this cases we saw the optic canal invasion by the tumor but we didn't try to decompress it. It was our archive group - we made this type of surgery before starting optic canal decompression. We use this group for found out the risks of canal decompression. This group shows the poor perspectives for the vision in optic canal invasion by the tumor without it decompression. We analyze the results of surgery on the day of discharge and on catamnesis - we decide that the optic nerves need time to recovery. We analyzed the results of surgery in patients with 3 types of the visual dysfunction: moderate (1.0-0.5), hard (0.5-0.1), decompensating (0.1-0). For showing the real risks and effectivety of any type of decompression and surgery without decompression we look for results in patients with decompensating of visual functions. For statistical analyses we use Fisher criteria which used in small series. We statistically showed that any attempts of tumor removal form the optic canal is more risky than decompression. Also we found a tendency that wide intradural decompresstion made by high speed drill with additional falciform ligament cutting and the dural sheet opening is more effective and safe than opening the optic canal by Kerrisson. This technique also could be used during the transcranial surgery for the other type of pathology particularly in cases with short optic nerves and prefixed chiasm - it gives the mobility for the nervesand decreased the nerve damaging.

Keywords:

optic nerve

optic chanel

transcranial decompression

Authors:

Kutin M.A.

NII neĭrokhirurgii im. N.N. Burdenko RAMN, Moskva

Kadashev B.A.

NII neĭrokhirurgii im. N.N. Burdenko RAMN, Moskva

Kalinin P.L.

NII neĭrokhirurgii im. N.N. Burdenko RAMN, Moskva

Serova N.K.

NII neĭrokhirurgii im. N.N. Burdenko RAMN, Moskva

Tropinskaia O.F.

NII neĭrokhirurgii im. N.N. Burdenko RAMN, Moskva

Andreev D.N.

GBOU VPO "Moskovskiĭ gosudarstvennyĭ mediko-stomatologicheskiĭ universitet im. A.I. Evdokimova" Minzdrava Rossii

Fomichev D.V.

Burdenko Neurosurgical Institute, Moscow, Russia

Sharipov O.I.

Burdenko Neurosurgical Institute, Moscow, Russian Federation

Turkin A.M.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Shul'ts E.I.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

SPIN RSCI: 3255-8587
Scopus AuthorID: 57112078200
ORCID: 0000-0001-5406-944X

Close metadata

References:

Kadashev B.A. Indications to different methods of treatment of pituitary adenomas. Summary of the Doctor of Medicine Thesis. Moscow 1992. In Russian.
Kadashev B.A., Kutin M.A., Kalinin P.L., Trunin Yu.K., Alekseev S.N., Shkarubo A.N. Comparative assessment of the results of different surgical treatments in patients with pituitary adenomas infiltrating the cavernous sinus. Vopr Neirokhir 2004; 3: 14-17. In Russian.
Kutin M.A., Kadashev B.A. Pituitary adenomas growing into the cavernous sinus: diagnosis and modes of treatment. Vopr Neirokhir 2005; 2: 27-30. In Russian.
Abe T., Satoh K., Wada A. Optic nerve decompression for orbitofrontal fibrous dysplasia: recent development of surgical technique and equipment. Skull Base 2006; 16: 3: 145-155.
Abuzayed B. et al. Endoscopic endonasal approach to the orbital apex and medial orbital wall: anatomic study and clinical applications. J Craniofac Surg 2009; 20: 5: 1594-1600.
Acheson J.F. Optic nerve disorders: role of canal and nerve sheath decompression surgery. Eye (Lond) 2004; 18: 11: 1169-1174.
Akdemir G., Tekdemir I., Altin L. Transethmoidal approach to the optic canal: surgical and radiological microanatomy. Surg Neurol 2004; 62: 3: 268-274; discussion 274.
Al-Mefty O. et al. Optic nerve decompression in osteopetrosis. J Neurosurg 1988; 68: 1: 80-84.
Attia M. et al. The importance and timing of optic canal exploration and decompression during endoscopic endonasal resection of tuberculum sella and planum sphenoidale meningiomas. Neurosurgery 2012; 71: 1: Suppl Operative: 58-67.
Attia M. et al. Giant anterior clinoidal meningiomas: surgical technique and outcomes. J Neurosurg 2012; 117: 4: 654-665.
Aurbach G., Reck R., Mihm B. Endonasal, endoscopic-microscopic control of the decompression of the optic nerve. An anatomic endoscopic presentation of the operation. HNO 1991; 39: 8: 302-306.
Bland L.I., Marchese M.J., McDonald J.V. Acute monocular blindness se-condary to fibrous dysplasia of the skull: a case report. Ann Ophthalmol 1992; 24: 7: 263-266.
Call N.B. Decompression of the optic nerve in the optic canal. A transorbital approach. Ophthal Plast Reconstr Surg 1986; 2: 3: 133-137.
Cebula H. et al. Endoscopic approaches to the orbit. Neurochirurgie 2010; 56: 2-3: 230-235.
Chang H.S. et al. Ultrasonic bone curettage for optic canal unroofing and anterior clinoidectomy. Technical note. J Neurosurg 2006; 104: 4: 621-624.
Chen C.T. et al. Endoscopically assisted transconjunctival decompression of traumatic optic neuropathy. J Craniofac Surg 2007; 18: 1: 19-26; discussion 27-28.
Chen Y.H. et al. Supraorbital keyhole surgery for optic nerve decompression and dura repair. J Neurotrauma 2004; 21: 7: 976-981.
Chen Y.R., Breidahl A., Chang C.N. Optic nerve decompression in fibrous dysplasia: indications, efficacy, and safety. Plast Reconstr Surg 1997; 99: 1: 22-30; discussion 31-33.
Chou P.I., Sadun A.A., Lee H. Vasculature and morphometry of the optic canal and intracanalicular optic nerve. J Neuroophthalmol 1995; 15: 3: 186-190.
Dallan I. et al. Endoscopic endonasal anatomy of superior orbital fissure and orbital apex regions: critical considerations for clinical applications. Eur Arch Otorhinolaryngol 2013; 270: 5: 1643-1649.
Day J.D., Giannotta S.L., Fukushima T. Extradural temporopolar approach to lesions of the upper basilar artery and infrachiasmatic region. J Neurosurg 1994; 81: 2: 230-235.
De Ganseman A. et al. Intranasal endoscopic surgery in traumatic optic neuropathy - the Belgian experience. Acta Otorhinolaryngol Belg 2000; 54: 2: 175-177.
Dumont A.S. et al. Cranioorbital fibrous dysplasia: with emphasis on visual impairment and current surgical management. Neurosurg Focus 2001; 10: 5: E6.
Edelstein C., Goldberg R.A., Rubino G. Unilateral blindness after ipsilateral prophylactic transcranial optic canal decompression for fibrous dysplasia. Am J Ophthalmol 1998; 126: 3: 469-471.
Fu J.D., Song W.X., Zhang J.L. Endoscopic decompression of optic canal. Zhonghua Yi Xue Za Zhi 2005; 85: 44: 3123-3125.
Fukado Y. et al. Remote results of surgery for decompression of the optic canal. Rinsho Ganka 1963; 17: 617-619.
Guyer D.R. et al. Visual function following optic canal decompression via craniotomy. J Neurosurg 1985; 62: 5: 631-638.
Hao Y.J., Wang J.T., Sun J.F. Experimental study on anatomy of adjacent structures of the optic canal. Zhonghua Yan Ke Za Zhi 2009; 45: 5: 412-416.
Hart C.K., Theodosopoulos P.V., Zimmer L.A. Anatomy of the optic canal: a computed tomography study of endoscopic nerve decompression. Ann Otol Rhinol Laryngol 2009; 118: 12: 839-844.
Hong Y., Lin P., Liang Z. Clinical study of decompression of optic nerve through combined orbit, ethmoid and sphenoid approach. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2001; 15: 12: 546-547, 549.
Horiguchi K. et al. Endoscopic endonasal trans-sphenoidal optic nerve decompression for traumatic optic neuropathy- technical note. Neurol Med Chir (Tokyo) 2010; 50: 6: 518-522.
Jaggi G.P. et al. Optic nerve compartment syndrome in a patient with optic nerve sheath meningioma. Eur J Ophthalmol 2007; 17: 3: 454-458.
Kennerdell J.S., Amsbaugh G.A., Myers E.N. Transantral-ethmoidal decompression of optic canal fracture. Arch Ophthalmol 1976; 94: 6: 1040-1043.
Knox B.E., Gates G.A., Berry S.M. Optic nerve decompression via the lateral facial approach. Laryngoscope 1990; 100: 5: 458-462.
Kong D.S. et al. Endoscopic optic canal decompression for compressive optic neuropathy. J Clin Neurosci 2011; 18: 11: 1541-1545.
Landeiro J.A. et al. Tuberculum sellae meningiomas: surgical considerations. Arq Neuropsiquiatr 2010; 68: 3: 424-429.
Lehmberg J. et al. Impact of anterior clinoidectomy on visual function after resection of meningiomas in and around the optic canal. Acta Neurochir (Wien) 2013.
Li-Hua C., Ling C., Li-Xu L. Microsurgical management of tuberculum sellae meningiomas by the frontolateral approach: surgical technique and visual outcome. Clin Neurol Neurosurg 2011; 113: 1: 39-47.
Li J. et al. Endoscopic anatomy research related to transsphenoidal optic nerve decompression. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2009; 23: 2: 52-54.
Li J. et al. Transsphenoidal optic nerve decompression: an endoscopic anatomic study. J Craniofac Surg 2008; 19: 6: 1670-1674.
Liu J.K. et al. Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach. Neurosurg Focus 2011; 30: 5: E2.
Locatelli M. et al. Endoscopic transsphenoidal optic nerve decompression: an anatomical study. Surg Radiol Anat 2011; 33: 3: 257-262.
Maniscalco J.E., Habal M.B. Microanatomy of the optic canal. J Neurosurg 1978; 48: 3: 402-406.
Margalit N.S. et al. Meningiomas involving the optic nerve: technical aspects and outcomes for a series of 50 patients. Neurosurgery 2003; 53: 3: 523-532; discussion 532-533.
Mariniello G. et al. Management of the optic canal invasion and visual outcome in spheno-orbital meningiomas. Clin Neurol Neurosurg 2013.
Mathiesen T., Kihlstrom L. Visual outcome of tuberculum sellae meningiomas after extradural optic nerve decompression. Neurosurgery 2006; 59: 3: 570-576; discussion 570-576.
Mortini P. et al. Visual outcome after fronto-temporo-orbito-zygomatic approach combined with early extradural and intradural optic nerve decompression in tuberculum and diaphragma sellae meningiomas. Clin Neurol Neurosurg 2012; 114: 6: 597-606.
Niho S. et al. Decompression of the optic canal by the transethmoidal route. Am J Ophthalmol 1961; 51: 659-665.
Norris J.H. et al. Optic canal decompression with dural sheath release; a combined orbito-cranial approach to preserving sight from tumours invading the optic canal. Orbit 2012; 31: 1: 34-43.
Onofrey C.B. et al. Optic canal decompression: a cadaveric study of the effects of surgery. Ophthal Plast Reconstr Surg 2007; 23: 4: 261-266.
Otto A.J. et al. Retrobulbar pressures measured during surgical decompression of the orbit. Br J Ophthalmol 1996; 80: 12: 1042-1045.
Pletcher S.D., Sindwani R., Metson R. Endoscopic orbital and optic nerve decompression. Otolaryngol Clin North Am 2006; 39: 5: 943-958, vi.
Rhoton A. Rhoton’s Cranial Anatomy and Surgical Approaches. Lippincott Williams & Wilkins 2007; 1 ed; 746.
Roser F. et al. The role of surgery in meningiomas involving the optic nerve sheath. Clin Neurol Neurosurg 2006; 108: 5: 470-476.
Sade B., Lee J.H. High incidence of optic canal involvement in tuberculum sellae meningiomas: rationale for aggressive skull base approach. Surg Neurol 2009; 72: 2: 118-123; discussion 123.
Samii M. et al. Optic nerve, topographic anatomy. In The cranial nerves. Berlin Heidelberg: Springer-Verlag 1981.
Schick U., Jung C., Hassler W.E. Primary optic nerve sheath meningiomas: a follow-up study. Cent Eur Neurosurg 2010; 71: 3: 126-133.
Takahashi M. et al. Microscopic intranasal decompression of the optic nerve. Arch Otorhinolaryngol 1989; 246: 2: 113-116.
Yilmazlar S., Saraydaroglu O., Korfali E. Anatomical aspects in the transsphenoidal-transethmoidal approach to the optic canal: an anatomic-cada-veric study. J Craniomaxillofac Surg 2012; 40: 7: e198-e205.