眉弓入路切除颅眶沟通性病变的临床观察.pdfVIP

北京医学2008年第30卷第1期 · 5 · ． 论著 ． 眉弓入路切除颅眶沟通性病变的临床观察 李永1 史季桐2安裕志2傅继弟1 张家亮1 张天明1 【摘要】 目的 探讨颅眶沟通性病变经眉弓入路的手术方法及疗效。方法 回顾性分析我院2005年3月至 2007年6月收治的21例颅眶沟通性病变患者的临床资料。对所有患者均经眉弓人路进行手术切除病变治疗，根据 术前眼眶CT、MRI检查采取合适的手术切口及骨瓣。结果 本组21例中肿瘤全切除14例，近全切除6例，大部切 除1例。术后一过性脑脊液鼻漏3例；上硷下垂8例，均于术后2～3个月恢复；额部皮肤麻木9例，其中眶上神经切 断6例未能恢复。术后18例患者随访1～24个月，平均 13个月。1例泪腺腺样囊性癌患者术后 1．5年复发。结论 合适的经眉弓人路能够充分显露颅眶沟通性病变，手术安全，并发症少，符合微创原则；部分患者眶上神经损伤为其 缺点。 f关键词】 眶肿瘤 颅底 微创外科手术 Resection of cranio-orbital communicating lesions through eyebrow incision Yong,SHIJi—tong,AN 一 ￡ (Department of Neurosurgery，Beijing Tongren Hospital，Beijing 100730) 【Abstract】Objective In~oducing a modified supraorbital keyhole approach with eyebrow incision and its surgical outcomes for cranio—orbital communicating lesions．Methods The clinical data of 2 1 cases from Mar 2005 to Jan 2007 were retrospectively studied．Patients ages ranged from 22 to 73 years with 48．8 years in average．Eight patients were male，13 were female．The chief compliants were progressive proptosis and loss of visual acuity．Based on the relation of lesion and tlle optic nerve，lesions were classified into four types：internal，lateral，middle and mixed．We used suitable eyebrow incision SO a one-piece supraorbital craniotomy Was made that incorporated the orbital rim and roof and the frontal process of the zygomatic bone．The orbital osteotomy facilitated the view of the anterior and middle cranial fossa through the operating microscope．Duration of follow up was I month to 2 years．Results Total tumor removal was achieved in 14 cases，subtotal removal in 4 cases，partial removal in 1 case．Postoperativel