海绵窦眶尖肿瘤的显微手术治疗

Microsurgical treatment of tumors in the cavernous sinus and orbital apex region

目的分析海绵窦眶尖肿瘤显微外科治疗的手术方法和治疗效果。方法回顾分析过去4年间,采用显微手术治疗18例海绵窦眶尖肿瘤的临床资料。所有病例均采用额颞切口(翼点入路),其中有5例加颧弓离断(扩大翼点入路)方法开颅。结果肿瘤全切除12例,次全切除3例,大部分切除2例,活检1例;无手术死亡及严重并发症,神经继发损伤症状出现率为44.4%。结论①现代影像学可明确海绵窦眶尖解剖结构,根据肿瘤大小、位置和侵袭范围,采用翼点入路、扩大翼点入路方法开颅;②熟练掌握解剖知识及手术技巧,选择恰当的手术入路,成功地手术切除和及时处理术后并发症等是治疗的关键;③颅底缺损应给予修补和重建,避免脑脊液漏及颅内感染也是一个关键的问题。

Objective To analyze the microsurgical methods and therapeutic effects of the tumors in the cavernous sinus and orbital apex region. Methods The clinical data of 18 patients treated by microsurgical operations in the past four years were retrospectively analyzed. Frontotemporal incisions (pterional approaches) were applied to all patients, among which five cases were given extensive pterional approaches. Results Total resection of tumors was attained in 12 cases, sub-total resection in three cases, partial resection in two cases, and biopsy in one case. Neither mortality nor serious complications happened. The incidence of nerve damages was 44.4%. Conclusions ①Modern imaging methods can define the anatomic structures in the cavernous sinus and orbital apex region. According to the size, location and invading range of the tumor, pterional or extensive pterional approach was chosen. ②It is crucial for the treatment to master the anatomic knowledge and operative skills, choose the appropriate approach, resect the tumor successfully, and manage the postoperative complications in time. ③The defect of the skull base should be mended and reconstructed. It is also crucial to avoid the cerebrospinal fluid leak and intracranial infection.