颅眶沟通性肿瘤经颅手术及其并发症

Transcranial operation for cranio-orbital conununicating tmnors and its complications

目的探讨颅眶沟通性肿瘤翼点入路经颅手术方法和技巧改进，总结其主要并发症的发生率，讨论避免手术损伤眶内正常组织的注意点。方法回顾性系列病例研究。回顾性分析37例颅眶沟通肿瘤患者的临床资料。所有患者采用翼点入路术式开颅，根据需要，用咬骨钳咬除眼眶内侧壁或外侧壁，去除眶顶板，小心分离并保护眶尖部能够显露的各眼外肌，用冷冻头冷冻肿瘤的眶内部分，小心分离其周围组织直至肿瘤摘除。如果肿瘤突破硬脑膜进入脑实质，则由神经外科医师处理其颅内部分。结果37例患者中，32例一次性完整摘除，5例因肿瘤广泛侵犯海绵窦或是蝶鞍，作姑息性摘除。经组织病理学检查证实，其中良性肿瘤28例，占75．67％（28／37），恶性肿瘤9例，占24．32％（9／37）。最常见的肿瘤是脑膜瘤，11例，占29．73％（11／37）。最多的并发症是眼外肌损伤，21例，占56．76％（21／37）。最严重的并发症是视力丧失，4例，占10．81％（4／37）。结论翼点入路经颅手术摘除颅眶沟通性肿瘤，易于暴露，手术视野好，肿瘤易于摘除。术中注意保护眶后部重要组织，可以减少术后主要并发症的发生率。

Objective To investigate the procedure of transcranial operation via pterional approach for cranio-orbital communicating tumors, to improve surgery skills, to summarize the incidence of main complications and to discuss tips for avoiding damage of the normal orbital tissues. Methods Pterional approach was adopted for the operation. After the medial orbital wall or lateral orbital wall was bitten with rongeur and the orbital roof was removed, the extraocular muscles at orbital apex were separated and protected. The head of condenser was used to freeze the tumor, and the tissue around the tumor was separated until the tumor was extirpated. In cases where the tumor penetrated the dura mater and invaded the brain, surgery was performed by neurosurgeons. Results In 37 cases, 32 cases undertook total resection of tumors and palliative resection was performed in 5 cases due to severe tumor invasion of the cavernous sinus or sphenoid sinus. Of the 37 cases, 28 cases were benign tumors and accounted for 75.67% of total cases （28/37） ; 9 were malignant tumors and accounted for 24. 32% （9/37）. Pathological examination showed that 11 cases were meningioma which was the most common type of tumor and accounted for 29. 73% of total cases（11/37）. The most common complication was injury to extraocular muscles, which occurred in 21 cases and accounted for 56.76% of all cases（21/37 ）. The most serious complication was vision loss, which occurred in 4 cases and accounted for 10. 81% of all cases （4/37）. Conclusions Resection of cranio-orbital communicating tumors via pterional approach provides a wide observation field and facilities exposing tumors. Protecting important tissues in posterior orbital region will result in less postoperative complications.