内镜辅助的眶上锁孔入路显微手术切除鞍区病变(附52例报告)

Neuroendoscope-assisted Microsurgery through Supraorbital Keyhole Approach for Lesions in Sellar Regions (a Report of 52 Cases)

目的总结内镜辅助的眶上锁孔入路显微手术切除鞍区病变的经验、手术方法与技巧。方法对52例鞍区病变均采用内镜辅助的眶上锁孔入路显微手术切除。此52例鞍区病变中,垂体腺瘤22例,颅咽管瘤8例,脑膜瘤7例及前循环不同类型动脉瘤15例。结果37例鞍区肿瘤中,肿瘤全切除31例(83.8%,31/37),次全切除或部分切除6例(16.2%,6/37)。15例动脉瘤均准确完全夹闭瘤颈,预后优良者13例(86.7%13/15)和轻残2例(13.3%,2/15)。全组病人无手术死亡及重残,且术前原有症状在术后均有明显不同程度的好转。结论内镜辅助的眶上锁孔入路显微手术能清楚显露鞍区病变与周围结构,创伤小,避免了重要结构的损伤,术后并发症少,效果好。

Objective To explore the experience in treating the lesions of the sellar regions by neuroendoscope-assisted microsurgery through supraorbital keyhole approach and its technique. Method Fifty-two patients with lesions of the sellar regions, of whom, 22 suffered from pituitary adenomas, 15 intracranial aneurysms of anterior circulations, 8 craniopharyngiomas and 7 meningiomas, were treated by neuroendoscope-assisted microsurgery through supraorbital keyhole approach. Results Of 37 patients with tumors of the sellar regions, 31 received total removal and 6 subtotal or part removal. All the aneurysmal necks were accurately clipped in 15 patients with intracranial aneurysms, of whom, 13 got excellent outcomes and 2 were mildly disabled. The symptoms in all the patients with lesions of sellar regions were improved after the surgery. No patients died of the surgery. Conclusions The lesions in the sellar regions can be exposed well by neuroendoscope-assisted microsurgery through supraorbital keyhole approach, neuroendoscope- assisted microsurgery through supraorbital keyhole approach can reduce the operative injury and complications, and is an effective and safe technique to treat the lesions of the sellar regions.