经眶上外侧入路切除鞍结节脑膜瘤

Microsurgical removal of tuberculum sellae meningioma via lateral supraorbital approach

目的评估经眶上外侧入路切除鞍结节脑膜瘤的可靠性和安全性。方法回顾性分析47例经眶上外侧入路治疗的鞍结节脑膜瘤病人的临床资料,并讨论手术技巧。结果 47例鞍结节脑膜瘤病人中,根据Simpson切除分级,Ⅰ级5例,Ⅱ级37例,Ⅲ级3例,Ⅳ级2例。肿瘤全切除42例(89%),次全切除5例(11%)。39例术前视觉障碍病人中,术后症状改善25例,保持不变10例,恶化4例。出院后3个月Karnofsky评分,恢复良好41例(87%),有轻微症状6例(13%),无重度残疾及死亡。随访3～93个月,1例病人术后4年肿瘤复发再次手术。结论经眶上外侧入路可以安全有效地切除各种大小的鞍结节脑膜瘤,手术并发症发生率低。

Objective To evaluate the reliability and safety of the lateral supraorbital(LSO)approach in resection of tuberculum sellae meningioma(TSM).Methods Clinical data of 47 TSM patients who were treated by LSO approach were analyzed retrospectively.The surgical skills were discussed.Results According to the Simpson resection grade,gradeⅠin 5 patients,gradeⅡin 37,gradeⅢin 3 and gradeⅣin 2.Complete tumor resection was achieved in 42 patients(89%)and subtotal tumor resection in 5(11%).Of 39 patients with preoperative visual deficit,the visual symptom was improved in 25 patients,remained unchanged in 10 and deteriorated in 4.According to the Karnofsky scores 3 months after discharge,the good recovery was observed in 41 patients(87%)and mild symptoms left in 6(13%).There was no severely disabled patients and death.All of the patients were followed up for 3 to 93 months,tumor relapse occurred in 1 patient 4 years after surgery who received the second surgery.Conclusion TSM of various sizes can be safely and effectively resected by LSO approach with lower surgical complication rate.