经眶上外侧入路手术切除鞍结节脑膜瘤（附34例报告）

Surgical resection of tuberculum seilae meningiomas through lateral supraorbital approach： A report of 34 cases

目的初步探讨经眶上外侧入路在鞍结节脑膜瘤手术治疗中的有效性和安全性。方法回顾性分析2013年6月至2017年6月山东大学齐鲁医院神经外科收治的34例鞍结节脑膜瘤患者的临床资料。所有患者均行经眶上外侧入路手术切除肿瘤。采用Simpson分级评估肿瘤的切除程度。根据患者的术后MRI及其神经系统症状改善情况评价手术的有效性，并根据术后并发症的发生情况评估手术的安全性。结果34例患者中，SimpsonⅠ～Ⅱ级切除30例，Simpsonm级切除4例。术后视力改善23例，无变化8例，视力损害较术前加重3例。术后发热3例，低钠血症3例，出现精神症状1例，脑水肿1例，癫痫发作2例。所有患者均获随访。随访时间为3～36个月，平均（12±5）个月。1例（3％）术后影像学检查结果证实复发，其余33例未见复发。结论经眶上外侧入路手术具有开关颅简单、快速，术野整洁，创伤小等优点，可有效治疗鞍结节脑膜瘤。

Objective To assess the reliability and safety of lateral supraorbital （LSO） approach in the surgical treatment of tuberculum sellae meningiomas （TSMs）. Methods A total of 34 patients underwent operation through LSO approach between June 2013 and June 2017 at Department of Neurosurgery at Qilu Hospital of Shandong University and their clinical data were retrospectively analyzed in this study. All patients underwent surgical resection of the tumor via LSO approach. The extent of resection of the tumor was assessed using the Simpson classification. The effectiveness of the procedure was evaluated based on the patient＇s postoperative MRI and improvement in neurological symptoms, and the safety of the procedure was assessed based on the occurrence of postoperative complications. Results All patients were followed up for 3 -36 months with an average of 12 ± 5 months. Of the 34 patients, 30 underwent Simpson Ⅰ -Ⅱ resection and 4 received Simpson Ⅲ resection. Postoperative visual acuity was improved in 23 eases, no change was reported in 8 cases, and visual impairment was worse than preoperative conditions in 3 cases. There were 3 cases of postoperative fever, 3 cases of hyponatremia, 1 case of psychiatric symptoms, 1 case of cerebral edema, and 2 cases of epileptic seizures. In 1 （3%） patient, postoperative imaging findings confirmed recurrence. Conclusions LSO approach has multiple advantages including simplified and fast skull opening and closing, clean operative field and small trauma, and it could be used in the effective treatment of TSMs.