颅眶沟通性病变临床特点及显微神经外科手术治疗

Clinical features and microsurgical treatment of cranio-orbital communicating lesions

目的探讨颅眶沟通性病变的临床特点和显微外科手术疗效。方法回顾性分析48例颅眶沟通性病变的临床资料,均行显微手术切除,经眶额入路16例,翼点入路21例,扩大翼点入路6例,额颞眶颧入路5例。结果病变全切除36例,次全切除6例,部分切除6例。术后发生硬膜下积液1例,颅内感染2例,经治疗后痊愈;无颅内出血及脑脊液漏等并发症发生。随访2～31个月,平均14.5个月;无肿瘤复发或进展47例,死亡1例。多数病人术前症状好转。术后新发视力、视野障碍3例,眼球活动障碍或复视8例。结论颅眶沟通性病变良性肿瘤居多,以脑膜瘤最常见;显微手术切除为首选治疗方法,全切除率高,术后并发症少,且症状改善率高。

Objective To investigate the clinical features and microsurgical outcomes of cranio-orbital communicating lesions.Methods Clinical data of 48 patients with cranio-orbital communicating lesions undergoing microsurgery were analyzed retrospectively,including transorbital-frontal approach in 16 patients, transpterional approach in 21, extended pterional approach in 6, frontotemporalorbitozygomatic approach in 5. Results Total resection was achieved in 36 patients, subtotal resection in 6 and partial resection in 6.Subdural effusion occurred in 1 patient and intracranial infection in 2 after the operation, and all were cured after the treatment. No intracranial hemorrhage and cerebrospinal fluid leak occurred. The patients were followed up for the mean time of 14.5 months,ranging from 2 to 31 months. No tumor recurrence or progression occurred in 47 patients and 1 patient died. The preoperative symptoms were improved in most patients. Furthermore, the new visual acuity and visual field disturbance occurred in 3 patients and new ocular movement disorder or diplopia in 8 after the operation. Conclusions Most cranio-orbital lesions are benign tumors, in which meningiomas are the most common. Microsurgical excision is the preferred treatment method for cranio-orbital lesions, with high rates of total resection and postoperative symptom improvement and lower incidence rate of complications.