polenovjournalРоссийский нейрохирургический журнал имени профессора А. Л. ПоленоваRussian Neurosurgical Journal named after Professor A. L. Polenov2071-2693Семинары, Конференции и Форумы10.56618/20712693_2022_14_3_46polenovjournal-105Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL PAPERSМенингиомы передней и средней черепных ямок: тактика выбора хирургического доступа и результаты 10-летнего хирургического опыта в нейрохирургической клинике ГАУЗ «МКДЦ»Meningiomas of the anterior and middle cranial fossa: decision-making strategy for approach and results of the 10-year surgical experience in the neurosurgical department of “ICDC”https://orcid.org/0000-0002-0134-1005ПичугинА. А.PichuginA. A.

Пичугин Арсений Анатольевич

Бутлерова ул., 49, Казань, Казань, 420012; Карбышева ул., 12А, Казань, 420101

Pichugin Arseniy Anatolyevich 

49 Butlerov st., Kazan, 420012; 12А Karbyshev st., Kazan, 420101

https://orcid.org/0000-0003-1227-8918АлексеевА. Г.AlekseevA. G.

Алексеев Андрей Георгиевич

Бутлерова ул., 49, Казань, Казань, 420012; Карбышева ул., 12А, Казань, 420101

Alekseev Andrey Georgievich

49 Butlerov st., Kazan, 420012; 12А Karbyshev st., Kazan, 420101

https://orcid.org/0000-0002-2017-7001ДаниловВ. И.DanilovV. I.

Данилов Валерий Иванович

Бутлерова ул., 49, Казань, Казань, 420012; Карбышева ул., 12А, Казань, 420101

Danilov Valeriy Ivanovich

49 Butlerov st., Kazan, 420012; 12А Karbyshev st., Kazan, 420101

https://orcid.org/0000-0003-3702-7488ПашаевБ. Ю.PashaevB. Yu.

Пашаев Бахтияр Юсуфович

Бутлерова ул., 49, Казань, Казань, 420012; Карбышева ул., 12А, Казань, 420101

Pashaev Bakhtiyar Yusufovich

49 Butlerov st., Kazan, 420012; 12А Karbyshev st., Kazan, 420101

https://orcid.org/0000-0002-4211-4538ПоповаТ. И.PopovaT. I.

Попова Татьяна Ивановна

Бутлерова ул., 49, Казань, Казань, 420012

Popova Tatiana Ivanovna

49 Butlerov st., Kazan, 420012

Казанский государственный медицинский университет; ГАУЗ «Межрегиональный клинико-диагностический центр»РоссияKazan State Medical University; State Autonomous Institution of Health Interregional Clinical Diagnostic CenterRussian FederationКазанский государственный медицинский университетРоссияKazan State Medical UniversityRussian Federation2022080820241434656Copyright © Пичугин А.А., Алексеев А.Г., Данилов В.И., Пашаев Б.Ю., Попова Т.И., 20242024Пичугин А.А., Алексеев А.Г., Данилов В.И., Пашаев Б.Ю., Попова Т.И.Pichugin A.A., Alekseev A.G., Danilov V.I., Pashaev B.Y., Popova T.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://polenovjournal.elpub.ru/jour/article/view/105

Выбор хирургического доступа является одним из главных вопросов в хирургии основания черепа, во многом определяющий успешный исход операции.

ЦЕЛЬ ИССЛЕДОВАНИЯ

ЦЕЛЬ ИССЛЕДОВАНИЯ: описание тактики выбора хирургического доступа к менингиомам передней (ПЧЯ) и средней черепных ямок (СЧЯ) в зависимости от их анатомических особенностей и анализ результатов лечения пациентов с менингиомами данной локализации в нейрохирургической клинике ГАУЗ «МКДЦ» в период с 2010– 2020 годы.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ: в период с 2010–2020 гг. в нейрохирургической клинике ГАУЗ «МКДЦ» выполнено 245 операции удаления менингиом базальной локализации ПЧЯ и СЧЯ с показателями летальности 2,8 %.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ: решение о варианте доступа принимается на основе размера опухоли, ее анатомии, локализации и связи с магистральными сосудами и черепными нервами. Критериями к выбору доступа являются его безопасность (степень контроля за сосудистыми магистралями и нервными структурами) и эффективность (радикальность удаления опухоли). Хирургические доступы, используемые в нейрохирургической клинике «МКДЦ» при удалении менингиом передней и средней черепных ямок, — субфронтальный, бифронтальный, птериональный, модифицированный орбитозигоматический, супраорбитальный трансбровный и эндоскопический трансназальный доступы. Таким образом, опухоль можно атаковать под разными углами, выбрав наиболее эффективную и безопасную траекторию работы. В некоторых ситуациях целесообразно поэтапное удаление опухоли с использованием разных доступов, а в некоторых — одномоментное сочетание транскраниальных и эндоскопических доступов.

Surgical approach selection is one of the main questions in skull base surgery that mostly determines the successful outcome of the surgery.

THE OBJECTIVES OF THIS STUDY are the decision-making tactics for approach selection and the results of the surgical treatment of patients with anterior and middle skull base meningiomas.

MATERIALS AND METHODS

MATERIALS AND METHODS: There were performed 245 surgeries of removal anterior and middle skull base meningiomas in the department of neurosurgery of the “Interregional Clinical and Diagnostic Center” (ICDC) with a mortality rate of 2,8 % in the period from 2010 to 2020 years.

RESULTS

RESULTS: The decision-making algorithm includes such criteria as the size and location of the tumor, involvement of neural and vascular structures in the tumor’s stroma and safety and efficacy properties of the surgical approach. The common approaches that are used in the department of neurosurgery of ICDC are unilateral subfrontal, transbasal bifrontal, pterional, modified orbitozygomatic, supraorbital eyebrow, and endoscopic transnasal approaches. Thus, the tumor can be attacked by multiple angles with the most effective and safe trajectory. In some cases, it is advisable to stage the tumor removal using approaches with different trajectories or combine transcranial and endoscopic approaches to facilitate the radicalism and safety of the surgery.

базальные менингиомыхирургические доступыхирургия основания черепаптериональный доступсупраорбитальный трансбровный минидоступэндоскопический трансназальный доступорбитозигоматический доступменингиомы бугорка и площадки основной костименингиомы переднего наклоненного отросткаольфакторные менингиомыменингиомы крыльев основной костименингиомы кавернозного синусаskull base meningiomassurgical approachesskull base surgerypterional approachsupraorbital eyebrow approachendoscopic endonasal approachorbitozygomatic approachtuberculum sellae meningiomaplanum meningiomameningioma of anterior clinoid processolfactory meningiomasphenoid wing meningiomameningioma of the cavernous sinusИсследование проведено без спонсорской поддержки.The study was performed without external funding.ReferencesJean WC. Skull Base Surgery: Strategies.; 2019.Jean WC. Skull Base Surgery: Strategies.; 2019.Song SW, Kim YH, Kim JW, et al. 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The authors declare that there are no conflicts of interest present.