经眶上外侧入路显微切除鞍区肿瘤20例临床分析

Microsurgical resection of seHar tumors via lateral supraorbital approach： clinical analysis of 20 cases

目的探讨眶上外侧入路（LSO）在鞍区肿瘤手术中的应用。方法回顾性分析采用LSO入路切除鞍区肿瘤的20例患者的临床资料，通过影像学检查、神经系统症状改善情况及相关评分量表来评估该入路的安全性与有效性。其中鞍结节脑膜瘤11例，颅咽管瘤4例，表皮样囊肿4例，垂体瘤1例。结果20例患者中肿瘤全切者17例（85％），平均手术时间（144．0±54．1）min，平均出血量（96．5±51．1）ml。术后出现发热4例，内分泌紊乱4例，癫痫1例，无其他手术并发症。15例术前存在视功能损害患者术后改善7例（46．7％），加重1例（6．7％）；随访3～46个月，平均19个月，随访Karnofsy评分中位数95分，Glasgow预后评分4．7分，随访病情改善者18例，死亡2例。结论应用眶上外侧入路能安全、有效地切除鞍区肿瘤，是一种简便易行、微创的手术方式，值得推广应用。

Objective To research the application of lateral supraorbital （LOS） approach for reseeting sellar tumors. Methods Clinical symptoms of 20 patients with surgery via LOS approach were analyzed retrospectively. According to the neuroradiological findings and the improvement of symptoms, and some score scale, the efficacy and safety of LOS were assessed for removing sellar tumors. There were tubereulum sellae meningioma （ n = 11 ）, eraniopharyngioma （ n = 4）, epidermoid cysts （ n = 4） and pituitary adenoma （n = 1 ）. Results Complete resection was achieved in seventeen patients （85%）. The mean operating time was 144. 0 ± 54 minutes and the mean intraoperative blood loss was 96. 5±51.1 ml. Four patients had post-operative fever, four had endocrine disorders, and one had seizure. No other complieations were noted. Fifteen patients had visual funetion impairment before operation, seven of which were improved while one was aggravated after surgery. The median Karnofsky score （3 -46 mon） was 95（0 -100） and the Glasgow outcome scale （GOS） at follow-up （ 3 - 46 mon） was 4. 7 （ 0 - 5 ）. In general, the outcomes were improved in 18 patients and the mortality was 2. Conclusion The resection of tumors at sellar region via lateral supraorbital approach is effecient, simple and minimally invasive, which can make the removal of the tumors reliably and safely. It is worthy to be popularized clinically.