经眉弓眶上锁孔入路显微手术治疗前颅底和鞍区病变

The supraorbital keyhole approach with an eyebrow incision for microsurgical treatment of lesions in the anterior skull base and sellar region

目的探讨经眉弓眶上入路治疗前颅底和鞍区病变的显微手术方法和效果。方法采用经眉弓皮肤切口,铣刀铣下3.5 cm×2.5 cm包括眶缘及部分眶板在内的额下骨瓣,采用常规显微手术器械分块切除肿瘤或者夹闭动脉瘤,必要时引入内镜辅助观察。结果 26例前颅底和鞍区病变均获治愈,2例出现一过性尿崩症,3例出现电解质紊乱,经药物治疗后好转,1例术后合并脑积水者行脑室-腹腔分流术。本组病例均无手术入路相关的并发症,近期随访疗效良好,无复发病例。结论经眉弓眶上锁孔入路是一种安全有效的处理前颅底及鞍区病变的手术入路途径,其优点在于微创性,能明显减少手术创伤,提供足够的鞍区手术空间,并能有效地处理病变。内镜术中辅助观察可减少神经血管结构的损伤,提高肿瘤全切率。

Objective To investigate the supraorbital keyhole approach with an eyebrow incision for microsurgical treatment of lesions in the anterior skull base and sellar region.Methods The skin incision through superciliary arch and an intra-frontal bone window（3.5 cm×2.5 cm） including orbital margin and part of orbital plate was performed.The tumors or aneurysms were treated by microsurgery and the endoscope was introduced when necessary.Results All 26 cases with lesions of the anterior skull base and sellar region were cured.Transient diabetes insipidus in 2 cases and electrolyte imbalance in 3 cases were successfully cured by medical treatment and hydrocephalus in 1 case was treated by ventriculoperitoneal shunt.No complication related to the surgical approach and no recurrence occurred during short-term follow-up.Conclusion The supraorbital keyhole approach with an eyebrow incision is a safe and effective surgical approach for the lesions of the anterior skull base and sellar region.It obviously reduces the injury because of minimal invasion and provides adequate surgical space in sellar region and effectively removes the lesions.Endoscope-assisted surgery can reduce the damage to nerves and blood vessels and increase the total resection rate of tumors.