眶上匙孔入路手术治疗鼻内型脑膜脑膨出

Supraorbital keyhole approach in the treatment of intranasal meningoencephaloceles

目的 探讨眶上匙孔入路内镜下微创手术治疗鼻内型脑膜脑膨出的可行性及其意义。方法 对 1 999年 1月～ 2 0 0 1年 1 2月收治的 7例鼻内型脑膜脑膨出患者行眶上匙孔入路内镜下手术治疗。于患侧眉弓内做约 3～ 4cm切口 ,外侧不超过眉毛 ,内侧至眶上孔 ,保留眶上神经血管束 ,眶上做一直径 2 0～ 2 5cm的圆型骨瓣 ,抬起额叶 ,显露颅底骨缺损部位 ,于缺损处切断疝出物 ,经鼻内切除。缺损以骨片、筋膜和自体脂肪、耳脑胶修复。结果 7例患者均一次手术治愈 ,随访 6～ 2 4个月 ,均无复发和脑脊液漏发生。结论 眶上匙孔入路内镜下手术治疗鼻内型脑膜脑膨出 ,安全、有效 ,创伤小 。

Objective To explore the effect and significance of endoscopic surgery for intranasal meningoencephaloceles via the supraorbital keyhole approach Methods From January 1999 to December 2001, seven cases of intranasal meningoencephaloceles were treated by mini invasive endoscopic surgery via supraorbital keyhole approach The operation was carried out through supraorbital keyhole craniotomy approximately 2 0～2 5 cm in diameter following a skin incision just in the eyebrow The roughly 3～4 cm skin incision began medial to the supraorbital nerve and ended within the lateral edge of the eyebrow After the frontal lobe was elevated and the skull base defects exposed, the hernia sac was cut off at bone defect and the lump was resected via nasal cavity The bone defect were repaired using bone flap, self fat, fascia of rectus abdominis muscle and Ear Brain Glue Results Seven patients were successfully treated at initial operation without recurrence and cerebrospinal fluid leak during follow up 6 months to 2 years after surgery Conclusion The supraorbital keyhole approach is a safe approach in the hands of experienced surgeons for the mini invasive treatment of meningoencephaloceles