眶颧入路切除前中颅窝底病变的临床分析

Clinical analysis of surgical treatment of anterior and middle cranial fossa lesions via modified orbitozygomatic approach

目的探讨应用美国Barrow神经外科中心改良双瓣法眶颧入路治疗前中颅窝底肿瘤的显微外科手术策略。方法回顾性分析经眶颧入路显微切除的12例前中颅窝底肿瘤患者的临床资料,对手术操作技巧及术后并发症等进行讨论。结果术后头颅MRI示蝶骨嵴脑膜瘤4例、海绵窦区海绵状血管瘤和三叉神经鞘瘤各1例、鞍旁高级别肉瘤1例及鞍区脑膜瘤1例,共8例完全切除; 3例海绵窦区脑膜瘤和1例岩斜区脑膜瘤大部切除。结论改良眶颧入路,对颅前、中颅窝底肿瘤提供了最佳暴露。该入路手术步骤相对简便,并且硬膜外即可处理肿瘤基底,减少肿瘤血供;该入路可以较好地显露前中颅窝底区域,并有效保护病变毗邻重要结构。

Objective To explore the microsurgical skills and strategies for the resection of anterior and middle cranial fossa lesions via modified Barrow s orbitozygomatic approach.Methods The clinical data of 12 patients treated by modified orbitozygomatic approach were collected and analyzed retrospectively.Surgical approaches and postsurgical complications were discussed.Results Postsurgical MRI images showed total resection achieved in 4 cases of sphenoid ridge meningiomas,1 cavernous sinus hemangioma,1 trigeminal neurinoma,1 parasellar sarcoma and 1 sellar region meningioma.Partial resection was achieved in 3 case of cavernous sinus meningiomas and 1 case of petroclival meningioma.Conclusions Modified orbitozygomatic approach can expose the spheno-orbital region well.Epidural management of the tumor base reduces the tumor blood supply greatly.This approach can expose the anterior and middle cranial fossa regions satisfactorily and protect the important structures around the lesions.