颅-眶肿瘤的微创技术处理

Management of cranio-orbital tumors with minimally invasive techniques

目的探讨采用微创技术处理颅眶肿瘤(COTs)的疗效。方法对56例颅眶肿瘤进行临床与影像学诊断,采用立体定向或神经导航技术,应用微创方法及不同手术入路切除肿瘤。全组病例中,肿瘤位于颅前凹49例,颅中凹7例,均累及眶腔的眶上嵴、眶顶或侧壁。其中38例(67.9%)有头痛、头晕等颅内压增高表现,53例(94.6%)出现视器症状。32例行数字减影血管造影(DSA)及术前颈外供瘤血管栓塞术。结果44例肿瘤(78.6%)获手术全切除,12例(21.4%)为次全切除。术后病人恢复良好,无死亡。对47例经信访或门诊随访6个月至9年(平均3.6年),38例(80.9%)恢复满意,余9例(19.1%)有不同程度后遗症。结论COTs多以视器改变为主要临床表现。选取不同的手术入路,在立体定向和神经导航辅助下,以微创技术处理本病,可明显地改善其预后。

Objective To probe the effectiveness of the cranio-orbital tumors (COTs) using the minimally invasive technique (MIT) management. Methods The COTs were diagnosed via the means of clinic and images for fifty-six patients. The tumors were excised utilizing the different operative approaches and the MIT, guided under stereotaxis or neuronavigation. In this series, all tumors involve into the orbital cavity from the anterior (49 cases) or middle fossa ((7 cases)), including the supraorbital ridge, orbital roof and lateral wall and floor in intracranial. The patients showed the headache, swirl as symptoms of intracranial hypertension in 38 cases ((67.9%)), and malfunction of optic organs in 53 ((94.6%)). Thirty-two of them were made the digital subtraction angiogram (DSA) and proceeded preoperative embolization of supplying arteries of tumors. Results The COTs had a total removal in 44 cases ((78.6%)) and subtotal removal in 12 ((21.4%)). The patients relovered well from the operation with no death in our group. Patients follow-up ranging from 6 months to 9 years with a mean of (3.6) years in 47 cases, showed that 38 cases ((80.9%)) resume normal life and 9 cases ((19.1%)) with different degree sequela. Conclusion Some alteration in optic organs is one of the most common clinical manifestation of COTs. The MIT, the different operative approaches, and the guidance under stereotaxis or neuronavigation may result in improved prognosis in evidence for these patients.