眶上和经眶上锁孔入路在鞍区显微手术中的应用比较

Supraorbital approach and trans-supraorbital approach in sellar microsurgery: a comparison study

目的比较眶上入路与经眶上入路在鞍区显微外科手术中的应用情况。方法总结25例鞍区肿瘤的手术经验,其中垂体腺瘤9例,颅咽管瘤6例,鞍结节脑膜瘤3例,蛛网膜囊肿4例,Rathke囊肿2例,上皮样囊肿1例。采用眶上入路17例,经眶上入路8例。部分病人术中采用神经内镜辅助技术。结果术后复查MRI,示眶上入路全切除13例,次全切除3例,部分切除1例;经眶上入路全切除和次全切除各为4例。眶上入路开颅操作简便,适用于大多数鞍区病变的手术。经眶上入路将锁孔技术与颅底外科技术结合运用,不仅将额叶的牵拉降至最低限度,而且对鞍区的显露较眶上入路视角向上增加了20°,操作径路也相应缩短。结论眶上入路适用于大多数鞍区肿瘤和囊性病变的手术切除,经眶上入路则适用于体积较大的鞍区肿瘤。内镜辅助技术可帮助术中确认手术效果,减少肿瘤残留机会。

Objective To compare clinical applications of supraorbital approach and supraorbital keyhole approach in sellar microsurgery. Methods Operative experiences of 25 cases were retrospectively analyzed, of whom 9 were pituitary adenomas, 6 craniopharyngiomas, 3 tuberculum sellae meningiomas, 4 arachnoidal cysts, 2 Rathke＇s cysts, and 1 was epithelioid cyst. 17 cases were treated via supraorbital approach, while 8 via supraorbital keyhole approach. Neuroendoscopy was used during the operation in part of the patients. Results MRI showed of 17 cases via supraorbital approach, total removal the tumor was achieved in 13 cases, subtotal in 3, and partial in l ; of 8 cases via supraorbital keyhole approach, total and subtotal removals were achieved in 4 cases respectively. Supraorbital keyliole approach combining keyhole technique and skull-base surgical technique not only made the stretching of frontal lobe be decreased to the lowest extent, but also increased 20 degrees of the visual angle to expose the sellar region and shortened the route to the target. Conclusions Supraorbital approach is simple, convenient, suitable for most sellar tumors, especially for cystic lesions, whereas supraorbital keyhole approach is suitable of the resection of larger tumors in the sellar region. Neuroendoscopy as assisted technique is useful for confirming the operative effect and reducing the chance of residual tumors intra-operatively.