眶尖区肿瘤改良经颅眶上外侧壁入路开眶显微术式治疗探讨

Surgical treatment of orbital apex tumors by refined transcraniai orbitotomy through superolateral approaches

目的 探讨眶尖区肿瘤改良经颅眶上外侧壁入路开眶治疗的显微外科手术策略及疗效.方法 回顾性分析48例眶尖区肿瘤患者的临床资料,采用改良经颅眶上外侧壁入路开眶,其中以眶-翼点为主34例,联合眶-额、眶灏、颧-翼点入路14例.术后常规复查增强MRI,并进行随访.结果 肿瘤全切除33例,次全切除7例,大部或部分切除6例,活检2例.术后视功能良好40例,存在动眼神经和视神经损伤7例,偏瘫1例.结论 改良经颅眶上外侧壁入路开眶结合显微技巧可较好治疗眶尖区肿瘤;合适的角度开眶可最大限度地切除眶尖区肿瘤和保护神经功能,减少不必要的创伤.

Objective To investigate the indications,approaches,and essentials of cranio-orbital surgeries for orbital apextumors.Methods The clinical data of 48 patients with orbital apextumors treated by refined transcranial orbitotomy through superolateral approach were analyzed retrospectively,34 tumors were excised with orbitoptenonal approach,while 14 tumors were excised with orbltotrontal approach,orbitozygomatic approach,or zygomatic-ptefional approach.Results Of the 48 orbital apextumors,33 cases were totally resected,7 cases were subtotally resected,and 6 cases were partly resected.The other 2 cases were taken biopsies.The optic functions improved or retained in 40 cases,7 cases suffered from eye-moving disfunction or visual-acuity declines,and 1 case suffered from hemiparalysis.Conclusions Tumors in the posterior and apex part of the orbit,or tumors extended from the orbit to the cranial,can be well treated through transcranial approach.Appropriate methods may help to bring maximum convenience to exposure and excision of the lesion,and to conserve the functions.Unnecessary injuries could be avoided as well.