颅眶交界区肿瘤的分型及手术治疗

Typing and surgical treatment of cranio-orbital tumors

目的探讨颅眶交界区肿瘤的分型及手术方法。方法根据肿瘤主体位置和侵袭方向,将32例颅眶交界区肿瘤分为眶颅型(7例)、颅眶型(11例)、颅鼻眶型(8例)和眶尖-视神经管型(6例)。均行显微手术切除肿瘤,其中采用经额下硬膜外入路11例,眶-翼点入路15例,额颞眶颧入路6例;对8例颅鼻眶型肿瘤联合使用经鼻内镜、鼻侧切开入路。术后按颅底缺损位置和范围分别采用游离骨膜瓣、人工脑膜补片及带蒂膜瓣修补硬膜缺损,并用钛板修复颅底骨缺损。结果肿瘤全切除27例,次全切除5例。无手术死亡及颅内感染、脑脊液漏、搏动性突眼等严重并发症发生。结论根据肿瘤主体位置和侵袭方向进行肿瘤分型和选择手术入路,显微手术切除颅眶交界区肿瘤,同时修复颅底缺损,能提高手术疗效和减少术后严重并发症的发生。

Objective To explore the typing of and surgical methods for cranio-orbital tumors. Methods The cranio-orbital tumors in the 32 patients were divided into 4 types according to the tumor location and growth direction： orbito-cranial type in 7 patients, cranio-orbital type in 1 l, cranio-naso-orbital type in 8 and orbital apex-optic canal type in 6. All the patients underwent microsurgical resection, 11 out of them were operated on via subfrontoepidural approach, 15 via supraorbital-pterional approach and 6 via frontotemporal-orbitozygomatic approach. Eight patients with cranio-naso-orbital type were operated on via combined transnasal and nasal lateral incision approach. Defect of the dura mater was mended with free periosteal flap, artificial dura patch or pericranial flap with vascular pedicle, and the skull base bone defect was repaired with titanium plate. Results Total resection was achieved in 27 patients and subtotal resection in 5. No patients died and no severe complications occurred, such as intracranial infection, cerebrospinal fluid leakage and pulsating exophthalmos. Conclusion Typing the tumor according to the tumor location and growth direction and chosing a suitable surgical approach in combination with repairing the skull base defects can improve surgical outcome and reduce the occurrence of severe complications after the surgery for cranio-orbital tumors.