颅眶沟通瘤的显微手术治疗及颅底缺损修复

Microsurgical resection of the cranio-orbital tumors and reconstruction of the skull base defects

目的探讨颅眶沟通瘤肿瘤的显微手术治疗的效果。方法35列患者根据肿瘤主体位置、大小和性质不同分别采用眶翼点入路(5例)、眶颧额颞(12例)入路和额眶入路(18例)进行显微切除手术。肿瘤切除后对前颅底骨质的缺损,分别采用游离骨膜加生物胶、带蒂额帽状腱膜瓣、带蒂颞肌筋膜瓣以及汰板加带蒂额帽状腱膜瓣等方法进行颅底缺损的修复。结果手术全切除28例,次全切除7例。手术后无脑脊液漏、搏动性突眼及颅内感染等严重并发症发生,无手术死亡。35例患者30例得到随访,随访时间8个月～10年。其中25例眼球突出患者22例术后恢复正常,3例明显减轻;26例视力视野损害患者22例术后恢复正常或明显好转,4例无明显变化;22例眼球运动障碍者术后18例灰复正常或明显改善,2例无变化,2例加重。结论肿瘤主体位置、大小和性质是决定选择不同手术入路的关键。术后根据前颅底骨质缺损的位置和范围不同,分别选择不同材料的修补方法能避免术后脑脊液漏等严重并发症的发生。

[Objective ]To explore the surgical technique and approach of the microsurgical resection of cranialorbital tumors. [Method] According to the individual condition of patients, thirty-five cases suffered with cranial-orbital tumors were treated by microsurgical treatment,of which 5 cases by orbital-pterioral approach, 12 cases by frontal-orbital-temporal approach and 18 cases by frontal-orbital approach. Skull-base defects were repaired by dissociated pericranial flap plus biogel, pedicled frontal galeal-peficranial flaps or pedicled temporal museulo-pericranial flaps. [Result] Total removed was achieve in 28 patients, subtotal removed in 7 cases. There was no mortality and no severe complications. Exophthalmos were disappeared in 22 of the 25 patients. Eyesight and field of vision were significantly improved in 22 of the 26 patients. Eyeball activity obstruction were significantly improved in 18 of the 22 patients. [Conclusion] On the bases of tumors＇ position, size and pathological character to select operative approach can improve results of the microsurgical treatment. According to the position and size of defect, using dissociated pericranial flap plus biogel, pedicled frontal galeal-pericranial flap or pedieled temporal musculo- pericranial flap to reconstruction the skull-base defect can avoid the incidence of serious complications.