动态牵拉技术在颅底肿瘤显微外科手术中的应用

Application of dynamic pulling technique in microsurgery of basicranial tumor

目的探讨无牵开器动态牵拉技术在颅底深部肿瘤显微外科手术中的应用效果。方法回顾性分析30例采用动态牵拉技术行显微神经外科手术治疗颅底深部肿瘤的患者临床资料,总结病例的特点、手术入路选择、病变种类、术后相关并发症及随访情况等。结果所有患者肿瘤均位于颅底,肿瘤直径1~3.5 cm,其中脑膜瘤24例,包括前颅底脑膜瘤5例、蝶骨嵴外侧及蝶骨平台脑膜瘤14例、岩斜区脑膜瘤5例;听神经瘤6例。采用的手术入路包括额颞入路、改良翼点入路、枕下乙状窦后入路等。术后出现术区挫伤伴少量出血2例,均予保守治疗;未出现二次手术及死亡病例;术后并发症包括嗅觉减退2例、动眼神经麻痹3例、面瘫2例。随访过程中患者术前症状及术后并发症均有不同程度改善,未出现肿瘤复发。结论在熟练掌握颅底解剖特点及神经外科显微操作基础上,通过无牵开器动态牵拉技术可有效提高颅底肿瘤的治疗效果,减少术后相关并发症的发生。

Objective To investigate the application efficacy of dynamic pulling technique without retractor in microsurgery of the deep tumors of the skull base.Methods The clinical data of 30 patients with deep tumors of the skull base treated by microsurgery combined with dynamic pulling technique were analyzed retrospectively.The characteristics of cases,surgical approaches,types of lesions,related complications after operation and follow-up information were summarized.Results All patients had tumors which located at the skull base,with the tumor diameter ranging from 1 cm to 3.5 cm.Among them,there were 24 cases of meningioma,including 5 cases of meningioma at the anterior skull base,14 cases of meningioma at the lateral sphenoid ridge and sphenoid platform,and 5 cases of meningioma in the petroclinal region;and there were 6 cases of acoustic neuroma.The surgical approaches included the frontal-temporal approach,modified pterional approach and suboccipital retrosigmoid approach.Two cases had postoperative contusion in the operative area with a small amount of bleeding and received conservative treatment.No secondary operation or death occurred.Postoperative complications included 2 cases of anosmia,3 cases of oculomotor palsy and 2 cases of facial paralysis.During the follow-up,the preoperative symptoms and postoperative complications of the patients were improved to varying degrees,and no tumor recurrence occurred.Conclusion On the bases of mastering the anatomical features of the skull base and the micro-operation of neurosurgery,dynamic pulling technique without retractor can effectively improve the treatment effect of the skull base tumors and reduce the incidence of postoperative complications.