眶颧额颞下入路显微切除中颅底肿瘤

Microsurgical Treatment of the Middle Cranial Base Tumors Through Frontotemperal -or -bitozygomatic Approach

目的初步总结经眶颧额颞下入路显微切除中颅底肿瘤的疗效和经验。方法回顾性分析近年来采用眶颧额颞下入路显微手术治疗的13例颅底肿瘤的分类、临床表现、影像学特征、手术技巧、切除程度和治疗结果。结果主要向中颅底生长的蝶骨嵴内1/3脑膜瘤3例,鞍旁-中颅窝底脑膜瘤4例,颅眶沟通脑膜瘤1例,下丘脑胶质瘤2例,主位于中颅窝底的脊索瘤2例,向鞍旁生长的巨大垂体瘤1例。2例肿瘤包裹同侧颈内动脉和大脑中动脉。术中切除颧弓4例。肿瘤全部全切,无术后死亡,术后尿崩2例,脑脊液漏并颅内感染1例,肺部感染1例。随访10例,死亡2例;术后8个月肿瘤复发1例。结论眶颧额颞下入路有肿瘤暴露充分、全切率高、并发症少等优点,适合于切除中颅底或主要向中颅底生长的相邻部位肿瘤。术中是否切除颧弓根据肿瘤的大小和生长方向而定。

Objective To survey primary outcome and excperience of middle cranial base tumors treated microsurgically by frototemperal-orbitozygo-matic approach in our institute.Mehtods Cate-gories,clinical manifes-titations,radiological features,sugical techniches,and surgical results of13cases of midlle cranial base tumors treated microsurgical-ly by frototemperal -orbit -ozygomatic approach were analyzed retrospectively.Results In this se-ries,there were3cases of meningiomas of the inner sphenoid ridge extended prominantly into the midlle cranial base,4cases of meningiomas located in the parasellar area and midlle cranial base,1case of craniorbital communicating meningioma,2cases of hypoencephalar gliomas,2cases of chor-domas prominantly located in the middle cranial base,1case of giant pituitary adenoma extending into the parasellar area.2cases of tumors enrosed the ipsilateral internal crotid artery and middle cerebral artery.The zygoma were removed intraop-eratively in4cases.Totall removal were achieved in all cases,and there were no postoperative death.Postoperative diabetes insipidus,cerebral spinal flu-id leakage accompanied by intracranial infection,and pulmanary infection occurred in1case,re-spectively.Follow-up were achieved in10cases,among them2patients died,another had tumor re-currence8months after surgery,and the others had no tumor recurrence and adopted their occupations.Conclusion Frototemperal -orbio -zygomatic ap-proach were suitable for removal of tumors located in the midlle cranial base or extending prominantly into the midlle cranial base,with many advantages such as exellent tumor exposure,high totall removal rates and less complications.Wether the zygoma were removed intraoperatively depended upon the size and extension of the tumors.