改良经颅眶上外侧壁入路治疗眶尖区肿瘤  

Surgical treatment of orbital apex tumors by refined transcranial orbitotomy through superolateral approaches

作　　者：陈菊祥[1] 严勇[1] 王潇文[1] 谢天浩[1] 徐涛[1] 周劲旭[1] 秦荣[1] 张晨冉[1] 张磊[1] 孙伟[1] 胡国汉[1] 丁学华[1] 孙克华[1] 卢亦成[1] 

机构地区：[1]第二军医大学长征医院神经外科,全军神经外科研究所,上海市神经外科研究所,上海200003

出　　处：《中华神经外科杂志》2013年第1期45-49,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金项目（30973076）;上海卫生系统优秀学科带头人（新百人）计划项目（XBR2011030）;上海市曙光学者计划项目（11sG37）

摘　　要：目的探讨改良经颅眶上外侧壁入路治疗眶尖区肿瘤的手术指证、入路选择和显微外科手术策略。方法回顾性分析经颅开眶治疗的眶尖区肿瘤55例，采用改良经颅眶上外侧壁开眶入路，其中以眶一翼点为主39例，联合眶一额、眶一颧、颧一翼点入路16例。术后常规复查增强MRI，并进行密切随访。结果肿瘤全切除38例（69．1％），次全切除7例（12．7％），大部或部分切除7例（12．7％），活检3例（5．5％）。术后视功能良好45例（81．8％），存在动眼神经和视神经损伤者9例（16．4％），偏瘫1例（1．8％）。结论经颅眶上外侧壁开眶结合显微技巧可较好治疗眶尖区肿瘤；合适的角度开眶可最大限度切除眶尖区肿瘤和保护神经功能，减少不必要的创伤。Objective To investigate the indications, approaches, and essentials of cranio -orbital surgeries for orbital tumors. Methods Fifty -five orbital tumors treated by refined transcranial orbitotomy through superolateral approaches ,from 2003 to 2011 ,were reviewed. Thirty- nine tumors were excised with orbltoptenonaI approaches, while lb were excised with orbltotrontat approaches, orbitozygomatic approaches, or zygomatic - pterional approaches. Results Of the 55 orbital tumors, 38 （ 69. 1% ） were totally reseeted, 7 （12.7%） were subtotally resected, and 7 （12. 7% ） were partly resected. The other 3 （5.5%） took biopsies. The optic functions improved or retained in 45 （81.8%） patients. Nine （16. 4% ） patients suffered from eye - moving disfunctions or visual - acuity declines, and 1 （ 1.8% ） patient suffered from hemiparalysis. Conclusions Tumors in the posterior and apex part of the orbit, or tumors extended from the orbit to the cranial, can be well treated through transcranial approaches. Appropriate methods may help to bring maximum convenience to exposure and excision of the lesions, and to conserve the functions. Unnecessary injuries could be avoided as well.

关 键 词：眼眶 眼眶肿瘤 显微外科手术 预后 

分 类 号：R739.7[医药卫生—肿瘤]