经眉弓处锁孔入路切除鞍区肿瘤24例报告

Trans-supraorbital keyhole appraoch microsurgery with an eyebrow incision for sellar tumors: Report of 24 cases

目的探讨经眉弓处锁孔入路手术切除鞍区肿瘤的可行性。方法复合静脉全麻，仰卧位。皮肤切121位于眉毛的外侧半，切121长3．5～4．0cm，将额肌骨膜瓣牵向上，眼轮匝肌骨膜瓣牵向下，颞肌牵向外侧，颅骨钻孔定位于颞线后方（关键孔），铣刀向内侧铣开，骨瓣大小约2cm×3cm，磨除眶缘上方颅骨的内缘以扩大显微手术视野。弧形切开硬脑膜，使基底朝向眶缘，轻轻抬起额叶，释放脑脊液，显露肿瘤并切除。结果肿瘤全切22例，2例颅咽管瘤后部残留部分肿瘤包膜。1例ACTH腺瘤术后肾上腺皮质功能低下，应用激素替代治疗；8例术后出现暂时性尿崩，均于1周内缓解。9例术前尿崩术后尿量明显减少。1例鞍隔脑膜瘤术后术侧视力障碍加重，1周后逐渐好转。18例术后3个月MRl未见肿瘤复发。结论经眉弓处锁孔入路手术切除鞍区肿瘤可行，可明显减少手术创伤，提供鞍区足够的手术空间，有效地切除病变，手术切口美观。

Objective To study the feasibility of trans-supraorbital keyhole approach microsurgery for sellar tumors. Methods The operation was conducted under combined intravenous general anesthesia and the patient was maintained at a dorsal position. A skin incision was made along the lateral eyebrow at 3.5 - 4.0 cm in length. The frontal muscle periosteous flap was draged upwards and the orbicularis muscle periosteous flap was dragged downwards. Then the tempotal muscle was dragged laterally. The position of the keyhole was located behind the temporal line. By using a milling cutter, a bone window 2 cm × 3 cm in size was made medially. The inner margin of the supraorbital skull was shaped to expand the visual field of microsurgery. The cerebral dura mate was opened curvily, with the base directing to the orbital margin. The frontal lobe was elevated gently and the cerebrospinal fluid was drained. The tumor was fully exposed and resected. Results Total resection of tumor was achieved in 22 cases, and part of posterior tumor membrane remained in 2 cases of craniopharyngioma. Hypoadrenocorticism occurred in 1 case of ACTH adenoma after operation and a hormone replacement therapy was required. Temporary postoperative diabetes insipidus occurred in 8 cases and was relieved after 1 week. The postoperative urinary volume decreased significantly in 9 cases of preoperative diabetes insipidus. Visual disorder on the operational side was aggravated after operation in 1 case of tuberculum sellae meningioma, and was gradually improved after 1 week. No recurrence was observed under MRI examination in 18 cases at 3 months after operation. Conclusions Trans-supraorbital keyhole approach microsurgery is feasible,and it gives minimal operational trauma, thorough resection of tumor, and good cosmetic outcomes.