PHẪU THUẬT NỘI SOI QUA MŨI ĐIỀU TRỊ U MÀNG NÃO TRÊN YÊN TẠI BỆNH VIỆN ĐẠI HỌC Y DƯỢC TP. HỒ CHÍ MINH NĂM (2022)

Abstract

Objective of the study. Following the benefits of the neurosurgical microscope, the outcomes in suprasellar meningioma surgery were significantly improved. More recently, endoscopic neurosurgery has been widely applied to remove these lesions with many outstanding advantages. The purpose of this study is to evaluate the results of transnasal endoscopic treatment for suprasellar meningiomas at our center. Subjects and research methods. Between 2017 and 2022, there were 22 patients with suprasellar meningiomas, who met the selection criteria and underwent transnasal endoscopic surgery to remove the tumor at Medical University Center in Ho Chi Minh City. Meningiomas include tuberculum sellae, planum sphenoidale region depending on the location of the tumor attachment. Follow-up after surgery by clinical examination, images post-op (MRI) at the time of hospital discharge, three months after surgery and doubling the time thereafter. Results. Among 22 patients with the suprasellar meningiomas, the patient's age varied from 30 to 74, mean: 56 and there was a clear predominance of female over male (76% female). Headache and vision loss are these most common symptoms accounting for 73% and 68% respectively. The most common tumor sites were the tuberculum sellae (64%). Complete tumor removal (Simpson I) 20 patients (91%). Tumors with vascular encasement and large size are the two main factors that make it difficult to remove the tumor completely (p < 0.05). Tumor location or tumor extension into the optic canal is not a predisposing factor to resection. Improved visual acuity 80%, one case worsen after surgery (4.5%). Complications of CSF leak 13.6% with one case requiring re-operation. Anosmia 9.1%, meningitis 13.6%, transient diabetes insipidus 9.1%, post-operative sinusitis 18%. Conclusions. Endoscopic endonasal surgery for suprasellar meningiomas with several major advantages of the endonasal route such as providing optimal tumor access window, less structural damage, devascularization is accomplished early in surgery by interrupting the dural blood supply during the approach and decompress the optic nerve from the beginning of the operation. Futhermore, this approach offers no brain retraction, no scars and shorter recovery time. Careful patient selection and experienced neurosurgeons will help us achieve maximum treatment results with minimal complications.