应用改良颅眶颧入路处理复杂性颅底病变

The modiffied orbitozygomatic approach for complicated skull base

目的 介绍应用改良颅眶颧入路处理复杂性颅底病变的手术方法及经验。方法 该入路采用“双瓣”技术 ,即首先行翼点开颅 ,取下额颞骨瓣。然后采用“六次切割”法 ,用气动锯分别割断颧弓根部、颧突、外侧眶缘和外侧眶壁、眶上缘和眶顶 ,取下眶 颧骨瓣 ,接下来进行硬脑膜内的显微操作。结果 本组 2 3例全部采用改良颅眶颧入路 ,术中发现该入路可缩短手术操作距离 ,对深部病变的观察角度明显扩大 ,降低了颅底病变的手术的难度。术后CT复查未见明显的脑牵拉性损伤 ,未发生额肌麻痹、眼球内陷、视力损害等并发症。结论 改良颅眶颧入路手术中没有骨质丢失 ,不需行眶顶重建 ,避免了术后的眼球内陷。另外 。

Objective To introduce the operative methods and experience for the modified orbitozygomatic (OZ) approach in dealing with the complicated skull base lesions.Methods We use the so called 'two flaps' technique for the modified OZ approach. Initially a frontotemporal bone flap was turned, followed by the six bone cuts with pneumatic saw to divide the root of zygomatic process, malar eminence, lateral orbital rim, lateral orbital wall, superior orbital rim as well as the orbital roof. After the orbitozygomatic bone flap was removed, the intradural microsurgery will be proceeded. Results Twenty three cases of skull base lesions were explored using the modified OZ approach. We experienced the significantly decreased operating distance and the widened viewing angle when handing the deep seated lesions, which has reduced the difficulty of microsurgical operation at skull base. Postoperatively, there was no any brain retraction injury demonstrated on CT scan in all cases, no evidence of enophthalmos, paresis of the frontal muscle, as well as the damage to the visual acuity.Conclusions The modified OZ approach eliminates the bone lose during operation, obviate the need for bone reconstruction of the orbital walls to prevent the postoperative complication of enophthalmos. It also minimizes the risk of injury to the frontal branch of the facial nerve and the damage to the eyeball.