单侧眶上小骨窗显微手术切除嗅沟脑膜瘤  

Unilateral supraorbital small craniotomy approach for the microsurgical removal of olfactory groove(menigiomas)

作　　者：朱安凯[1] 万经海[1] 李长元[1] 

机构地区：[1]安徽医科大学第一附属医院神经外科,安徽合肥230022

出　　处：《中华神经外科疾病研究杂志》2006年第1期50-54,共5页Chinese Journal of Neurosurgical Disease Research

基　　金：安徽省卫生厅第五批科研基金资助项目(2002A010)

摘　　要：目的 推介一种经额微创的嗅沟脑膜瘤手术入路-单侧眶上小骨窗入路。方法 从2000年12月到2004年12月，17例嗅沟脑膜瘤采用单侧眶上小骨窗入路切除肿瘤。肿瘤直径小于7cm5例，小于6cm2例，小于5cm10例。单侧生长4例，对称生长10例，偏侧生长3例。临床症状以头痛（13例）、视力下降（12例）、嗅觉丧失（14例）为主。翼点入路皮肤切口，眶上缘上方形成带颞肌蒂小骨瓣（2．0～3．5cm），电灼切断肿瘤基底，瘤内分块切除，最后分离分块切除瘤皮。结果 所有病例肿瘤全部切除，其中SimpsonⅠ级3例，SimpsonⅡ级14例。额叶保护良好，无脑脊液漏。随访6个月到4年，未见影像学上复发。结论 单侧眶上小骨窗入路能满足不同大小、生长方向嗅沟脑膜瘤切除所需操作空间。开颅快，微创。显露肿瘤基底直接。利于容貌保护。Objective To provide a micro-invasive surgical approach to olfactory groove menigiomas,unilateral supraorbital small craniotomy approach. Methods Between December 213130 and December 21304, a series of 17 patients underwent micresurgical tumor resection using the unilateral supraorbital small craniotomy approach. Bilateral expanded tumors underwent operation on the right side and unilateral or partial expanded tumors underwent operation on the tumor at the side where the main part was located. In 17 patients, the tumor＇s diameter measured less than 7 cm in 5 cases, less than 6 cm in 2 cases, less than 5 cm in 10 cases. The clinical presentation included headache in 13 patients, visual impairment in 12 patients, and anosmia in 14 patients. The advantages of the approach were to expose the base of tumor early, which followed by a safe rapid and complete devaseularization of the tumor and later resection of the inner-tumor tissues. Then the capsular area of tumor was dissected from the frontal vascular branches. The dural attachment was coagulated or totally excised by bipolar or monopelar, The patient with basal expansion ＇after the bone infiltration was drilled. The anterior cranial floor was reconstructed with the pericranial flap. Results Total removal was achieved in all cases. The Sinoson Ⅰ degree dissection was achieved in 3 cases and Sinoson Ⅱ in the others 14 cases. All patients presenting with headache or visual deficits recovered or improved, but anosmia failed to recover. Postoperative computer tomography or magnetic resonance imaging confirmed complete tumor removal ＇and demonstrated the brain parenchyma had been preserved and intactness on the side opposite to the craniotomy achieved. Conclusion Supraorbital small craniotomy approach provides enough operative room to resect the olfactory menigiomas with various sizes and different expanding directions. Craniotomy by this approach is faster and mini-invasive. The base of tumor is expesed directly and the features of the patients am protected t

关 键 词：眶上小骨窗入路 嗅沟脑膜瘤 手术方法 

分 类 号：R651.11[医药卫生—外科学] R739.4[医药卫生—临床医学]