翼点入路在显微神经外科的临床应用

CLINICAL APPLICATION OF PTERIONAL APPROACHES IN MICRONEUROSURGERY

目的 :介绍和总结经翼点入路显微手术切除鞍区与颅底病变的临床应用与经验。方法 :回顾性分析一组经翼点入路进行显微外科治疗的病例。结果 :多数病例获得良好恢复 ,显微镜下肿瘤全切率为 5 6 % ,8例脑动脉瘤夹闭成功。术后 1例出现动眼神经损害 ,偏瘫 1例 ,死亡 1例。结论 :翼点入路可对前、中颅底 ,鞍区病变进行良好暴露 ,适用蝶骨嵴脑膜瘤、垂体瘤、颅咽管瘤、 Willis环的动脉瘤等颅底外科手术。掌握该入路的显微外科技术 ,可提高肿瘤全切除率 ,减少术后并发症。

Objection:To describe and discuss the microsurgical operative experience of excision with transepterional approach.Methods:A series of 42 cases which were operated via the pterional craniotomy were analyzed retropectively.Results:Most of patients received a good recovery.19/34(56%) tumors have been totally removed microsurgically with this approach.In all patients with aneurysm complicate surgical occlusion of the aneurysm via the pterional approach was achieved.In one patients parisis of the oculomotor nerve and in another hemiplegia occurred postoperatively.One patients died during the immediate postoperatively period.Conclusions:The pterional approach provided excellent exposure of middle fossa and parasellar area.It is commonly employed in surgery of anterior circulation artery aneurysm,as well as for the tumors arising from the medial sphenoid ridge and lesions around the sella such as pituitary adenoma and craniopharyngioma.Pterional approach with microsurgical technique can improve the rate of total tumor removal and can decrease the mortality and morbidity.