翼点入路切除鞍上大型颅咽管瘤的显微手术技巧

Microsurgical Techniques for Total Removal of Large Suprasellar Craniopharyngiomas via Pterional Approach

目的 为探讨大型鞍上颅咽管瘤经翼点入路全切除的显微手术技巧。方法 随访分析和回顾总结我科63例颅咽管瘤病人手术治疗和预后情况,介绍充分开放外侧裂、暴露切除肿瘤、合理利用各手术间隙、重要组织结构保护及关键器械使用等方面的技巧。结果 本组全切51例,次全切12例,无手术死亡。经该入路切除鞍区肿瘤路径短、损伤少、暴露充分;在传统四个手术间隙基础上,合理使用颈内动脉上间隙增加了肿瘤的直视范围和角度,更有利于肿瘤的切除。结论 翼点入路是鞍区肿瘤手术的理想入路。熟悉显微解剖,充分利用各手术间隙及娴熟的显微操作技巧是全切肿瘤的基础和关键。

Objective To explore the microsurgical techniques for total removal of the large suprasellar craniopharyngiomas via the pterional approach. Methods The clinical data of 63 patients with suprasellar craniopharyngiomas resected by the microsurgery was analyzed retrospectively. The microsurgical technique of opening Sylvian fissure, exposure and removal of tumor, sufficient utilizing the operative spaces and protection of vital structures was used. Results Of 63 patients with suprasellar craniopharyngiomas, 51 underwent total removal and 12 subtotal. No patients died of the operation. The pterional approach used in removing sellar tumors has the advantages such as the short working distance, minimal injury to the neural structures and sufficient exposure. Besides the traditional operative spaces, the supracarotid space provides an optional angle and the wide direct visualization for the operation. Conclusions The pterional approach is an ideal one for removal of the suprasellar craniopharyngioma. It is the key to success in total removal of the tumor to be familiar with the relevant anatomy, sufficiently utilizing the operative spaces and microsurgical techniques.