经颅眶入路治疗视神经胶质瘤

Cranial-orbital approach in the treatment of optic nerve glioma

目的总结经颅眶入路治疗视神经胶质瘤的经验。方法回顾性分析了经颅眶入路切除视神经胶质瘤患者的临床资料，共35例患者，36次手术，其中男26例，女9例；年龄1～54岁，平均13岁。临床表现以意识下降突眼为主，病程1～36个月。诊断方法包括CT、MRI，35例肿瘤均经病理学诊断。结果肿瘤全切除29例、近全切除6例。手术并发症：一过性脑脊液鼻漏2例、白内障1例，无眼球运动障碍。随访3个月～8年，随访到27例（77．1％）肿瘤复发3例，脊髓种植1例，死亡1例。结论视神经胶质瘤手术切除效果较好，但是视神经管内易残余肿瘤，术后应辅以放射治疗。

Objective To summarize the experience in cranial-orbital approach in the treatment of optic nerve glioma. Method The clinical data of 35 patients with optic nerve glioma diagnosed by CT and MRI, 26 males and 9 females; aged 13 （1 -54）, with the main clinical presentations of visual defection and ex-ophthalmos and with the courses from 1 to 36 months, who underwent operation via the cranial-orbital approach 36 times, were analyzed. The diagnosis was confirmed by pathology after operation in 35 cases. Follow-up was conducted for 3 months to 8 years. Results Total resection was achieved in 29 cases, and subtotal resection in 6 cases. The surgical complications included temporary cerebrospinal fluid rhinorrhea （2 cases） and cataract （ 1 cases）, and no ocular movement dysfunction was found. The follow-up rate was 77.1% （27/35）. Three cases suffered from recurrence, spinal metastasis was found in 1 case, and 1 case died. Conclusion resection of optic nerve glioma via cranial-orbital approach is effective. However, since residual tumor may remain in the optic nerve canal, post-operative radiation therapy is recommended.