经眉眶上匙孔手术治疗前颅底、鞍区病变

Supra-orbital eyebrow keyhole approach for treating lesions in anterior fossa and sellar region

目的：探讨经眉眶上匙孔入路处理前颅底、鞍区病变的手术技巧和适应证。方法回顾分析2002年1月-2012年12月经眉眶上匙孔入路处理前颅底、鞍区病变46例患者的临床资料,其中嗅沟脑膜瘤13例（长径3~4.5 cm）、鞍结节脑膜瘤17例（长径2~3.5 cm）、垂体柄占位活检3例、垂体瘤3例、颅内动脉瘤10例（前交通动脉瘤6例、后交通动脉瘤4例）。结果嗅沟、鞍结节脑膜瘤、垂体瘤均全切,垂体柄占位成功获取病理组织,动脉瘤亦成功夹闭；2例术后并发脑脊液鼻漏,1周后痊愈；新增尿崩症1例,1月后痊愈。结论经眉眶上匙孔入路适于选择性前颅底、鞍区病变的微创手术治疗。

Objective To explore the surgical techniques and indications of supra-orbital eyebrow keyhole approach for treating lesions in anterior fossa and sellar region. Methods Forty-six cases from February 2002 to December 2012 were retrospectivel analyzed, including 13 cases of olfactory groove meningiomas （tumor size 3-4. 5cm）, 17 cases of tuberculum sellae meningiomas （tumor size 2-3. 5cm）, 3 cases of pituitary stalk mass （ biopsy） , 3 cases of pituitary adenoma and 10 cases of intracranial aneurysms （6 cases of anterior communicating artery and 4 cases of posterior communicating artery aneurysms）. Results All meningiomas and pituitary andenomas were totally removed. Mass of the pituitary stalk was diagnosed by pathology. Aneurysms were completely clipped. Two patients experienced with cerebrospinal flud rinorhea and recovered one week later. One patient suffered transitory diabetes insipidus, and recovered one month later. Conclusions Supra-orbital eyebrow keyhole approach is a useful minimally invasive approach to treat selected anterior fossa and sellar region lesions.