眶上外侧入路在鞍区肿瘤显微手术中的评估

Clinical evaluations of lateral supraorbital microsurgical approach for sellar tumors

目的：评估眶上外侧入路是否能安全有效的切除鞍区肿瘤。方法回顾性分析苏州大学附属第一医院年6至12月期间行连续性眶上外侧入路肿瘤切除术的鞍区肿瘤患者临床资料，重点分析临床表现、影像资料、术中情况及术后随访结果。共23例患者，其中垂体瘤11例（48％），鞍结节脑膜瘤6例（26％），颅咽管瘤6例（26％）。结果23例中21例术中肿瘤完全或大部分切除（91％）。术后所有患者均无并发脑脊液瘘或出现新的视野缺损。并发颅内感染1例（4.3％），并发术后颅内出血1例（4.3％）。术后Karnofsy评分中位数87.4分，Glasgow预后评分4.6分。术后效果满意21例，重度残疾1例，术后死亡1例。结论眶上侧入路相对其他鞍区病变经颅手术入路在能安全切除鞍区肿瘤的同时，具有手术时间短、技术难度要求低的优点，且并发症及死亡率低。

Objective To assess the efficacy and safety of lateral supraorbital （ LSO） approach for removing sellar tumors.Methods Between June 2011 and December 2011, 23 patients with neoplastic lesions underwent surgery via a LSO approach.Their clinical manifestations , neuroradiological findings , microsurgical techniques and post-discharge outcomes were analyzed.There were pituitary adenoma （ n=11, 48%）, tuberculum sellae meningioma （ n =6, 26%） and craniopharyngioma （ n =6, 26%）.Results Complete tumor removal was achieved in 21 patients.There was no postoperative onset of cerebrospinal fluid leakage or new visual deficits.One patient had intracranial infection and another developed hematoma.The median Karnofsky score at discharge was 87.4 （0-100）.The Glasgow outcome scale at discharge was 4.6 （1-5）.Among them, the outcomes were favorable （n =21）, severe disability （n =1） and surgical mortality （ n =1 ）.Conclusion Sellar tumors may be removed via a LSO approach with relatively low morbidity and mortality.And this fast and simple procedure is comparable to more extensive , complex, and time-consuming approaches .