经眉弓眶上锁孔入路切除鞍区颅咽管瘤

Study on transsupraorbital approach for excision of craniopharyngoima in the sella region

目的 探讨经眶上锁孔入路切除鞍区颅咽管瘤的应用价值。方法 对21例位于鞍上,肿瘤上下径为3.0-6.5cm的颅咽管瘤患者（部分囊性变者13例,完全实性者8例）,作眉弓内弧形小切口,在眶上铣开一为2.5cm×3cm的半圆形小骨瓣,术中根据肿瘤位置,从Ⅰ、Ⅱ、Ⅲ间隙和终板入路切除肿瘤。术中除注意保护视神经、垂体柄、下丘脑之外,还应防止损伤颈内动脉、后交通动脉、脉络膜前动脉和大脑后动脉发出的到下丘脑和前穿质部位穿通动脉的损伤。结果 术中肿瘤全切除18例、次全切除3例,术后7例出现不同程度的尿崩症及电解质紊乱,经药物治疗后好转,13例患者视力改善。结论 眶上锁孔入路切口小,能提供鞍上区足够的手术空间,足以显露鞍区病变及其邻近结构,且减少了脑牵拉和手术创伤,有利于颅咽管瘤的全切除,是一种安全有效的处理鞍区病灶手术入路途径。

Objective To discuss the application of transsupraorbital approach for excision of craniopharyngoima in the salla region. Methods 21 cases of craniopharyngoima in suprasellar region were resected by trans - supraorbital approach, the diameter of tumors varied from 3.0 to 6.5cm; partial cystic tumor in 13 and solid tumor in 8. Skin incision was made in eyebrow, the hemicycle bone flap was approximately 2.5cm×3.0cm, tmnor was dissected in Ⅰ, Ⅱ, Ⅲ spaces and trans - endplate. Great attention was paid not only to the optical nerve , stalk hypophysial, hypothalamus, but also to the preservation of the perforating arteries from the structure of the hypothalamus and anterior perforated substance. Results 18 cases of tmnor were removed totally, 3 cases were removed subtotally,7 cases had different degree of diabetes insipidus and electrolyte disturbance, those conditions were improved by the drug treatment, the visual acuity of 14 cases was improved. Colldusion The supraorbital approach requires a much smaller skin incision, but could provide sufficient operating space in the suprasellar region for tumor removal which not only makes excellent surgical exposure for tumor and other structure in sella region and diminish brain retractionand tissue trauma, but also benefits for total excision of craniopharyngioma. So it is an effective and safe operative approach for tumor in the sella region.