经额部纵裂入路术中切断前交通动脉的可行性分析

Frontal interhemispheric approach to tumor removal with division of the anterior communicating artery

目的经额部纵裂终板入路切除鞍区和视交叉后部肿瘤，前交通动脉切断后以利于肿瘤切除，探讨切断前交通动脉的安全性。方法采用经额部纵裂入路切除鞍区和视交叉后部肿瘤14例，术中切断前交通动脉以利于肿瘤的显露和切除。结果8例颅咽管瘤全切除。3例视神经胶质瘤：1例大部切除，1例近全切除，1例全切除。1例嗅沟脑膜瘤近全切除，1例鞍背脑膜瘤大部切除。1例生殖细胞瘤做活检。14例没有手术死亡。1例前交通动脉的宽度为3mm被切断，术后双侧大脑前动脉区和右侧基底节区缺血，病人呈浅昏迷状态。余13例的前交通动脉宽度4～10mm，切断后没有缺血改变。结论经额部纵裂终板入路，当前交通动脉妨碍肿瘤的显露和切除时，且前交通动脉的宽度在4mm以上时，可以安全地切断前交通动脉。

Objective The use of a frontal interhemispheric approach with division of the anterior communicating artery （ACoA） for removal of sellar and retrachiasmatic areas tumors. Whether or not this division can provide wide operative field and be safe. Method From Jan 2001 to Oct 2006, 14 cases of sellar and retrachiasmatic areas tumors undertook surgery with division of the ACoA. All cases underwent the frontal interhemispheric approach to achieve good excision of the tumors. Results 8 craniopharyngiomas were totally removed. 3 optic chiasmtic gliomas were tottally, subtotally, and partially removed respectively. One olfactory meningoma was subtotally removed, one sella dorsum meningoma was partially removed. One germinoma was biopsy. One case of chiasmtic glioma with division of the 3 mm width of the ACoA was stupor postoperatively. With the ACoA over 4 mm width, there were no ischemic symptoms with the division of ACoA, postoperatively. Conclusions When the ACoA limited to the operative exposure and over 4 mm width, the artery could be divided safely.