Transcranial optic schwannoma resection

Glioma is more common in optic nerve tumors, followed by meningiomas and schwannomas originating from nerve sheaths. Children and young people have better differentiation of optic gliomas and long survival after total resection; adult optic gliomas are mostly high-grade, and Taphoorn et al (1989) review 30 cases of literature, only 1 to 2 years after surgery. Meningiomas and schwannomas can be completely cut, but the retention rate of visual acuity after meningiomas is low. Treatment of diseases: optic glioma Indication (1) One side optic nerve tumor, confirmed by X-ray of the skull, CT or MRI examination, the visual crossover has not been violated. (2) Optic schwannomas and meningioma have invaded the optic chiasm, severe visual impairment of the eyes or complete loss of vision, but resection of the tumor can still improve the condition. Contraindications High-grade optic gliomas have invaded the optic chiasm, loss of vision in both eyes, or tumors have invaded the hypothalamus and temporal lobe. Surgery can not save vision and prolong life. Surgical procedure 1. Surgical incision: a coronal incision in the bilateral forehead of the forehead, the flap being turned forward. 2, bone flap craniotomy: the frontal forehead of the affected side to do 4 skull drilling, the inner and lower skull hole should avoid the frontal sinus, the bone flap turned to the temporal side. 3, dural incision and exploration of intracranial tumors: dural valvular incision, the base is attached to the upper frontal cortex, and the brain plate is pulled back along the frontal lobe. First, the intracranial segment and the optic chiasm of the optic nerve are explored. If no tumor is found, and the optic nerve thickened by the tumor invasion is not seen, it is better not to cut the intracranial segment of the optic nerve at this time, but wait for the exploration inside the sac. Once the tumor is found and confirmed by biopsy as an optic glioma, it can re-enter the cranial cavity. In order to prevent postoperative tumor recurrence, the affected side should be cut off just before the optic chiasm. If the cranial cavity and the intracranial segment of the optic nerve are first detected as optic nerve tumors and confirmed by pathological examination as optic glioma, the optic nerve should be cut off before the optic chiasm, and the biopsy should be sent immediately. If it is confirmed that there is no tumor cell at the end, it is suggested that the tumor has been completely removed. If there are still tumor cells at the end of the fracture, the lateral intersection of the affected side should be considered. If the glioma has invaded all the optic chiasm, that is, or the tumor tissue is removed, the postoperative tumor will also recur rapidly, and it can only rely on radiotherapy without removing the tumor. 4, orbitotomy (orbitotomy): the dura mater from the affected side of the anterior cranial fossa above the tarsal plate, drilled with a skull, then expand the bone window with a rongeur, forward to the frontal plate, Adjacent to the screen plate, outward to the side wall of the crucible, and close to the tip of the crucible. If the preoperative optic nerve hole examination has been proved to enlarge the side optic nerve hole, it indicates that the tumor has invaded the intracranial segment of the optic nerve canal or optic nerve. That is, the optic nerve upper wall bone should be removed to a thin layer with a micro drill, and then the upper wall of the optic canal is removed with an ultra-thin Kerrison rongeur or curette to reveal the optic nerve sheath. 5, fascia incision: the cross-shaped incision of the fascia, with the suture through the edge to retract around, revealing the muscles, nerves and blood vessels in the sacral structure. 6. Tumor exposure: After revealing the internal structure of the iliac crest, it is operated under the operating microscope to recognize the important structure in the iliac crest. The superior oblique structure, the superior levator levator and the superior rectus muscle are visible from the inside to the outside, and the inner edge of the levator muscle from the upper iliac crest. Move forward into the trochlear nerve of the superior oblique muscle. Generally, the gap between the superior oblique muscle and the superior levator muscle is used. It has also been suggested that the gap between the superior levator ani muscle and the superior rectus muscle or the gap between the superior rectus muscle and the lateral rectus muscle. The levator levator muscle is pulled to the outside by a silk thread, and the muscle can be cut off if necessary, and the tumor is re-stitched after the tumor is removed. When separating between the superior oblique muscle and the upper levator ani muscle, the tumor is searched for in the loose honeycomb tissue, and the supraorbital artery and the parasitic nerve and sieve parallel to the ophthalmic artery are often encountered on the path. The posterior artery is retained where possible. It is generally easier to find a thickened optic nerve and a glioma therein, or a meningioma attached to the optic nerve, or a schwannomas. At this time, a tumor biopsy is taken to confirm the tumor properties. 7, tumor resection; if biopsy confirmed as meningioma or schwannomas, should be stripped under the operating microscope, patiently and meticulously separate the tumor from the optic nerve fibers, to achieve full tumor resection, and retain useful vision. If it is confirmed to be an optic glioma, the anterior pole of the tumor is first peeled off, and the optic nerve is cut off at the posterior pole of the eyeball, and then the posterior pole of the tumor is removed from the tip of the sac. If the tumor has been extended into the optic canal, even if the optic canal extends into the cranial cavity, the optic nerve and its glioma should be stripped from the optic canal. At this time, regardless of the posterior pole of the optic glioma in the sacral, optic canal or intracranial segment of the optic nerve, the affected side of the optic nerve should be cut in the immediate vicinity of the optic chiasm, and the optic nerve should not be left behind, so as not to increase the chance of tumor recurrence. If the optic glioma has invaded the surrounding brain structure, the tumor should be removed. 8, eyelid treatment: after tumor resection, with bipolar coagulation completely stop bleeding. As mentioned above, the levator muscle has been cut before the tumor is revealed, and it should be sutured at this time. The fascia and the bone defect of the upper wall of the iliac crest are then sutured. Some people use sputum or plexiglass to repair, while Gabibov does not advocate repair, and there is no postoperative eyeball pulsation. 9, Guan skull: suture the dura mater, bone flap reduction, drainage of the dura mater, suture the periosteum, cap-like diaphragm and skin layer by layer. complication If the frontal sinus or ethmoid sinus can cause cerebrospinal fluid rhinorrhea, conservative treatment can not be self-healing for several weeks, and surgery should be repaired.