眶上“锁孔”入路在治疗鞍上区病变中的应用

Application of superaorbital keyhole approach in treating tumor or aneurysm at the sellaturica

目的 总结眶上锁孔入路在治疗鞍上区病变中的应用结果与经验。方法 分析1999年1月至2001年12月由眶上锁孔入路治疗的28例鞍上区病变患者的病变情况,手术经过及术后处理等过程。结果 本组18例肿瘤患者中,全切除13例,次全切除5例;10例动脉瘤均成功行夹闭术,随访4-30个月,术前9例有视力,视野改变者,6例明显改善,2例好转,1例无变化。内分泌改变的8例中,有5例恢复正常,3例改善。术后有3例发生尿崩,经物治疗2周后痊愈。结论 眶上锁孔入路切口小,但是以显露鞍区病变及其邻近结构,且减少了恼组织暴露和手术创伤,是处理鞍上区病灶的理想手术入路之一,病灶主体位于鞍上区与周围组织粘连不太紧密的肿瘤或者前循环动脉瘤可作为该入路的适应症。

Objective To summarize the results and experience of supraorbital keyhole approach used for the patients with tumors or aneurysms at superincumbent sellaturcica. Methods 28 cases with tumor or aneurysm near the sellaturcica treated with a supraorbital keyhole approach since January 1999 were analyzedretrospectively in theirpathological changes, operation and post-operation treatment Results In the 18 patients with tumors at the Sellaturcica area, total resection of the tumor was carried out in 13 cases and partial resection in another 5 cases. 10 aneurysms were successfully closed with clamp. All 28 patients were followed up for 4 to 30 months. In the 9 cases with disorder in eyesight or visual field, 6 were obviousiy ameliorated, 2 patients on the mend, only l had little improvement. In the 8 cases with abnormal endocrine, 5 were recuperated and 3 on the mend. The 3 patients with diabetes insipidus at post-operation were cured after 2-week medical treatment. Conclusion In the operation for the lesions at superincumbent sellacturica with the supraorbital keyhole approach, the cut on the skull is small. There is fewer brain tissues exposed and there is little surgical trauma at the operation. The keyhole is ideal for exposing enough the focal lesion and the anatomic structure near it to accomplish the surgical procedure. Aneurysm and tumors with little adherence local on the superincumbent sellaturcica can be the adaptations of the supraorbital keyhole approach.