经眶上锁孔入路切除鞍区大型肿瘤的显微手术技巧探讨

Microsurgery through Supraorbital Eyebrow Key Hole Approach for Large Tumors of Sellar Regions

目的探讨经眶上锁孔显微手术切除鞍区大型肿瘤的技巧。方法对63例瘤体为3.0cm×2.0cm×2.0cm～11cm×9cm×9cm的鞍区大型肿瘤(包括33例垂体腺瘤,16例颅咽管瘤,9例脑膜瘤及胚胎生殖细胞瘤、视神经纤维瘤、胶质瘤、巨大蛛网膜囊肿和拉克囊肿各1例),采用经眶上锁孔入路手术切除,并探讨肿瘤显露、切除方法和重要神经结构和血管的保护方法。结果肿瘤全切56例(88.9%),大部分切除7例,未全切者部分病例行放射治疗。术后1例死亡。术后主要并发症有尿崩症、硬膜下积液。随访5月～4.5年(平均2.6年),3例肿瘤复发。结论采用眶上锁孔入路显微手术切除鞍区大型肿瘤效果好、创伤轻,并节省手术时间。

Objective To explore the surgical technique through supraorbital eyebrow key hole approach to large tumors of the sellar regions. Methods Sixty-three patients with the large or huge tumors in the sellar regions including putuitary adenoma, craniopharyngioma, meningioma and so on, were treated by microsurgery through supraorbital eyebrow key-hole approach. The tumor sizes ranged from 3.0 cm×2.0 cm×2.0 cm to 11 cm×9 cm×9 cm. The methods to expose and resect the tumors, and to protect the important cerebral areas, vital vessel and nerves from the operative injury were studied. Results Of 63 cases of the tumors, 56 were totally resected and 7, which were treated by radiotherapy after the operation, were in great part reaected. One patient died after the surgery. Main postoperative complications included diabetes insipidus （3 cases）, subdural fluid collection （6 cases）. Following-up from 5 months to 4.5 years （mean, 2.6 years） showed that the tumors recurred in 3 patients. Conclusions The curative effect of microsurgery through supraorbital eyebrow key hole approach, which has advantages such as mild operative damage, saving time, and craniotomy with small bone widows, on the large tumors in the sellar region is very good.