眶上锁孔手术入路的临床扩展应用

Extended clinical application of supraorbital keyhole approach

目的总结经眶上锁孔手术入路切除鞍区肿瘤、外伤性脑脊液鼻漏修补、视神经损伤和额叶脑内血肿清除等手术经验,扩大经眶上锁孔手术入路的临床应用范围。方法对采用经眶上锁孔手术入路治疗的32例患者的临床资料进行回顾性分析,其中鞍区肿瘤16例,脑脊液鼻漏5例,视神经损伤3例和额部颅内血肿8例。结果32例患者都得到了良好疗效。16例鞍区肿瘤患者全切12例,次全切4例。5例脑脊液鼻漏患者全部治愈,3例视神经损伤患者2例视力明显好转,1例无变化。8例额叶脑内血肿患者全部治愈。所有患者无严重并发症和死亡病例。结论经眶上锁孔手术入路不仅适合鞍区肿瘤切除,只要病例选择适当,在脑脊液鼻漏、视神经损伤和额叶脑内血肿清除等病例中也可以得到广泛应用。

Objective To summarize the surgical experience of using the supraorbital keyhole approach for resection of sellar region tumors,repair of traumatic cerebrospinal fluid(CSF)leaks,treatment of optic nerve injuries,and evacuation of frontal lobe intracranial hematomas,and to expand the clinical application scope of the supraorbital keyhole approach.Methods A retrospective analysis was conducted on the clinical data of 32 patients who underwent surgery using the supraorbital keyhole approach.The patients included 16 cases of sellar region tumors,5 cases of traumatic CSF leaks,3 cases of optic nerve injuries,and 8 cases of intracranial hematomas in the frontal lobe.Results All 32 patients achieved favorable outcomes.Among the 16 patients with sellar region tumors,12 underwent gross total resection and 4 underwent subtotal resection.All 5 patients with traumatic CSF leaks were cured,and among the 3 patients with optic nerve injuries,2 showed significant improvement in vision while 1 showed no change.The 8 patients with frontal lobe intracranial hematomas all achieved complete recovery.No serious complications or deaths were observed in any of the patients.Conclusion The supraorbital keyhole approach is not only suitable for resecting sellar region tumors but can also be widely applied in cases of traumatic CSF leaks,optic nerve injuries,and evacuation of frontal lobe intracranial hematomas,provided appropriate patient selection.