额颞眶颧入路切除颅中窝底肿瘤

Surgical Excision of Tumors in the Middle Cranial Base Via Frontotemporal Obito-zygomatic Approach

目的 探讨额颞眶颧入路的特点及其切除颅中窝底肿瘤的手术技巧和适应证。方法 本入路是将额颞开颅颅骨切除的范围扩大到包括眶上缘、眶外侧壁及颧弓,以增加肿瘤的暴露,有利于肿瘤的切除。采用该方法对22例颅中窝底肿瘤进行手术,取得良好效果。其中脑膜瘤9例,垂体瘤8例,神经鞘瘤2例,脊索瘤2例,海绵状血管瘤1例。结果 获得肿瘤全切除者13例,次全切除6例,大部分切除3例,无手术死亡和严重手术并发症。结论 初步手术结果令人满意,该入路具有以下优点:①显露良好。可直视下切除的肿瘤范围广;②术野平面低,最大限度地减少了脑牵拉;③可从不同的方向显露并切除肿瘤,对同时侵袭颅内外、硬膜内外的肿瘤切除较彻底。

Objective To evaluate the characteristics, the indications of frontotemporal obito-zygomatic approach, and the operative skills for removing middle cranial base tumors. Methods Data from 22 patients with the middle cranial base tumors, who were operated via frontotemporal obito-zygomatic approach, was analysed reerospectively. During the operation, en bloc osteotomy including the superior and lateral orbital rims and zygomatic arch was performed together with the fronto-temporal craniotomy. Histo-logical diagnosis was meningioma in 9, pituitary adenoma in 8, neurinoma in 2, chordoma in 2 and cavernous angioma in 1. Results In this series of patients, total removal of tumors was achieved in 13 cases, subtotal in 6 and partial in 3. There was no operative mortalily and no serious complication occurred after the surgery. Conclusions The authors summarized the advantages of this approach as follows: (1)To provide better exposure of the tumor and a lower operative field plane for the surgery than the traditional approach, making the access easier to lesions located in the vicinity of the skull base with minimal or even without cerebral retraction; (2)It may be helpful to exposing the tumor in different directions especially those which had involved both the intra-and extra-cranial or dural space.