摘要
目的探讨经眶上锁孔入路切除鞍区颅咽管瘤的应用价值.方法对7例位于鞍上,肿瘤上下径为3.5～6cm的颅咽管瘤患者(部分囊性变者4例,完全实性者3例),作眉弓内弧形小切口,在眶上铣开一直径为2.5cm的半圆形小骨瓣,术中根据肿瘤位置,从视交叉前间隙,视神经外侧间隙和颈内动脉外侧间隙切除肿瘤.术中除注意保护视神经、垂体柄、下丘脑之外,还应防止损伤颈内动脉、后交通动脉、脉络膜前动脉和大脑后动脉发出的到下丘脑和前穿质部位穿通动脉的损伤.结果术中6例病人肿瘤全切除,1例病人次全切除,术后5例病人出现不同程度的尿崩症及电解质紊乱,经药物治疗后好转,6例病人视力改善.结论眶上锁孔入路切口小,但能提供鞍上区足够的手术空间,足以显露鞍区病变及其邻近结构,且减少了脑牵拉和手术创伤,有利于颅咽管瘤的全切除,是一种安全有效的处理鞍区病灶手术入路途径.
Objective To discuss the usefulness of trans-supraorbital approach for excision of craniopharyngioma in the sella region.Methods 7 cases of craniopharyngioma in suprasellar region were resected by trans-supraorbital approach,the diameter of tumors varied from 3.5cm to 6cm;partial cystic tumor in 4,and solid tumor in 3.Skin incision was made in the eyebrow,the diameter of hemicycle bone flap was approximately 2.5cm,tumor was dissected in the parachiasmal,opticocarotid,carotidotentorial spaces.Great attention was paid not only to the optical nerve,stalk hypophysial,hypothalamus,but also to the preservation of the perforating arteries from the carotid,posterior communication artery and posterior cerebral artery,anterior choroidal arteries to the structure of the hypothalamus and anterior perforated substance.Results 6 cases of tumor were removed totally,1 case was removed subtotally,5 cases had different degree of diabetes insipidus and electrolyte disturbance,those conditions were improved by the drug treatment,the visual acuity of 6 cases was improved.Conclusion The supraorbital approach required a much smaller skin incision,but could provide sufficient operating space in the suprasellar region for tumor removal,not only achieved excellent surgical exposure for tumor and other structure in sella region,may diminish brain retraction and tissue trauma,but also benefited for total excision of craniopharyngioma,was an effective and safe management to exsect tumor in the sella region.
出处
《立体定向和功能性神经外科杂志》
2005年第3期167-170,共4页
Chinese Journal of Stereotactic and Functional Neurosurgery
关键词
眶上入路
锁孔
颅咽管瘤
显微手术
Supraorbital approach
Keyhole
Craniopharyngioma
Microsurgery
