眶上锁孔入路的临床应用

Clinical application of supra-orbital keyhole approach

目的探讨眶上锁孔入路的临床合理应用。方法选择2000年6月-2004年6月鞍区病变患者36例,其中垂体肿瘤30例,鞍区脑膜瘤3例,颅咽管瘤2例,后交通动脉瘤1例;采用眶上锁孔入路,沿眉弓做切口,切口长度约5cm,骨窗范围长约3.5cm,宽2.5cm,弧形切开硬脑膜,在显微镜和神经内镜的辅助下完成手术。结果36例中30例垂体肿瘤者手术全切除率为80.00%(24/30),次全切除率13.33%(4/30);脑膜瘤3例均达到辛普森Ⅱ级切除;颅咽管瘤2例,1例全切除,1例次全切除;夹闭后交通动脉瘤1例。16例垂体肿瘤患者于手术后出现一过性尿崩症,2例伤口发生脑脊液漏,1例手术后额叶内小血肿,1例手术后视力较术前减退,1例伤口感染。手术中嗅神经保留完好,无一例死亡。结论眶上锁孔入路可增加手术的安全性,减少创伤,对于部分颅前窝及鞍区病变,眶上锁孔入路完全可以替代传统的经额手术入路。

Objective To study the rational clinical application of supra-orbital keyhole approach in operation. Methods Supra-orbital keyhole approach was adopted in patients with sellar region lesions during June 2000 to June 2004, among them there were pituitary adenoma 30 cases, meningioma 3 cases, craniopharyngioma 2 cases and posterior communicating artery aneurysm 1 case. The operations was performed with 5 cm skin incision on the eyebrow, bone window ranged 3.5 cm in length and 2.5 cm in width, under microscope and endoscope. Results Supra-orbital keyhole approach was performed in 36 patients. Of the 30 cases with pituitary adenoma, total removal rate was 80.00% (24 cases), subtotal removal rate was 13.33% (4 cases). In 3 cases with meningioma were performed Simpson grade Ⅱ removal. Of the 2 cases with craniopharyngioma, 1 total removal and another 1 subtotal removal were achieved. Posterior communication aneurysm of 1 patient was clipped. Of the 36 patients 16 cases with pituitary adenoma occurring of temporay postoperative diabetes insipidus, and wound CSF leakage (n = 2), frontal lobe heamatoma (n = 1), vision decreased (n = 1), wound infection (n = 1) were found. The cranial nerve was protected successfully in all cases. None death was occurred. Conclusion Supra-orbital keyhole approach in operation is safe and minimally invasive, thus the traditional transfrontal approach can be replaced for treating some lesions in anterior skull base and sellar region.