内窥镜控视下微创手术前额部肿块切除

Endoscope-assisted microneurosurgery for anterior frontal mass

目的前额外露部位的皮下或颅骨肿块,手术切除后,会在原肿块部位留下明显的瘢痕,影响美观.本文探讨经发际内切口,在内窥镜辅助下,切除前额部皮下或颅骨肿块.方法15例患儿,男6例,女9例,年龄2～6岁,平均3岁.肿块位于前额部及眶上颅骨表面或皮下,直径1～2cm.手术选取离肿块最近处发际内皮肤切口,约2 cm长,通过皮下隧道至肿块表面,在内窥镜引导下,将肿块切除.结果肿块性质:表皮样囊肿8例,皮样囊肿5例,钙化上皮瘤2例.15例肿块均完整切除,无伤口感染、皮下积液、皮肤坏死等并发症.随访3～12个月,无复发.结论内窥镜辅助下发际内切口同样能够完整切除前额部肿块.其优点是瘢痕仅在发际内而脸面外露部位无瘢痕,有良好的美容效果,提高患儿生活质量.

Objective Conventional operation on anterior frontal skull or subcutaneous mass leaves an unsightly scar on the face. We here introduce a new technique of endoscope-assisted operation, using hairline approach to remove anterior frontal skull mass. Methods We treated 15 patients with lumps on the frontal,temporal or orbital skull. The patients＇ age ranged from 2 years to 6 years（mean age, 3yr）. The follow up period ranged from 3 to 12 months. The mass was small, presented as a painless swelling in the subcutaneous tissue, covered with normal skin and fixed to the underlying tissue. On CT scanning, the lesion was hypodense and only involved the outer cranium table. Using a hairline incision （about 2 cm）, a subcutaneous tunnel was created. Through the subcutaneous tunnel,guided by the endoscopic video image, the mass was completely excised. Results Skull lumps were removed completely in all patients. The pathology shows： epidermoid cysts （8 cases）, dermoid cysts （5 cases）, calcifying epithelioma （2 cases）. There was no infection,subcutaneous fluid collection or skin necrosis. Conclusions Applying endoscope- assisted technique, anterior frontal skull mass can be removed completely through hairline approach with an excellent cosmetic result.