颅眶及球后眶内肿瘤手术治疗:附16例临床分析

Surgical Treatment of Neoplasms involving Cranio-orbital and Postglobal Intraorbital Regions:Analyses for 16 Cases

背景和目的:颅眶区解剖复杂,有许多孔隙、开口与颅内、眶内相通。由于肿瘤邻近重要的颅神经和血管,手术切除和重建颅底往往困难。本文探讨经颅入路切除颅眶沟通性肿瘤和球后眶内肿瘤的手术方法。方法:回顾性分析16例经颅入路手术切除的颅眶沟通性肿瘤和球后眶内肿瘤的临床资料,分别采用经额经眶上缘入路和经眶上-翼点入路进行。结果:全切除肿瘤14例,次全切除2例。手术后患眼失明1例,动眼神经麻痹2例,无手术死亡,手术效果满意。结论:经颅入路切除颅眶沟通性肿瘤和球后眶内肿瘤时,根据肿瘤所在眶内的位置选择恰当的手术入路是手术成功的前提,合理的手术方式和熟练的手术技巧是提高全切率、减少并发症的关键。

BACKGROUND ＆ OBJECTIVE.. The anatomical structures in cranial orbital area are very complicated since there are many fissure, openings or canals connecting cranial and orbital cavity. Due to the spatial closeness of tumor mass to the cranial nerves and cerebral vessels, it is indeed difficult to remove the tumor and to reconstruct the defect at skull base. In this paper, we will present our surgical experience of neoplasms involving cranio-orbital and postglobal intraorbital regions by tanscranial approaches. METHODS： Sixteen cases of neoplasms involving cranio-orbital and postglobal intraorbital region were retrospectively analyzed. The surgery was done by using one of the tanseranial approaches, including transerbitorimal-subfrontal approach and transerbitocygomatic approach. RESULTS： The tumor total removal was achieved in 14 cases and subtotal removal in 2 cases. Postoperative permanent oculomotor nerve palsy was found in 2 cases and homolateral blindness occurred in 1 case. There was no operative death and other severe complications. Surgical effect was satisfactory. CONCLUSIONS：Adequate surgical approach according to tumor,lecation is the basis of surgical success. Appropriate surgical approach with experienced surgical technique is the key to total tumor removal and minimizing surgical complication in treating tumors involving cranio-orbital and postglobal intraorbital regions.