改良眶颧入路的临床应用  

Clinical application of modified orbitozygomatic approach

作　　者：张激扬 吴安华[2] 

机构地区：[1]解放军第四六三医院神经外科,沈阳110001 [2]中国医科大学附属第一医院神经外科

出　　处：《临床神经外科杂志》2013年第1期31-33,共3页Journal of Clinical Neurosurgery

摘　　要：目的介绍改良眶颧入路治疗破裂的前交通动脉瘤及颅眶沟通性神经鞘瘤。方法 11例患者均采用改良眶颧入路,形成额颞骨瓣首先取下,然后沿眶上缘分离眶骨膜,分离的距离2～3 cm,向上分离至眶上孔,向下向后分离至额颧缝处,不显露整个颧弓。在眶上孔的侧方切断眶上缘,在颧突的上方颧骨额突处切断眶侧缘。结果复查头MRI示颅眶沟通性神经鞘瘤2例全部切除,9例前交通动脉瘤术后DSA证实夹闭完全,未出现额叶精神症状。3名患者术后出现过短暂的眼球外展功能受限及复视,4～6个月后完全恢复。结论采用改良额颞眶颧入路,技术简单,缩短手术时间,去掉更多的骨性结构,以获得更大的手术暴露范围,手术效果良好。Objective To explore modified orbitozygomatic approach for ruptured anterior communicating artery aneurysmas and schwannogliomas involving the cranio-orbital region. Methods 11 cases were treated by modified orbitozygomatic at first, then along surpraorbital rim, the orbital approach. Frontoemporal bone piece was taken out periosteal was seperated upward to supraorbital foramen and down and backward to frontoemporal suture. The length of seperation was about 2 - 3 cm,which avoided reveal of whole zygomatic arch. Surpraorbital rim was resected at supraorbital foramen side, and orbital lateral margin was reseeted up zygomatic forehead axon. Results 2 cases schwannogliomas involving the cranio-orbital region were completely resected, which was demonstrated by MRI. 9 cases ruptured anterior communicating artery aneurysmas were clipped fully , which was comfirmed by post operatioin DSA. All 9 cases had no frontal mental symptoms. 3 cases had appeared transient eye outreach function limition and diplopia. All 3 cases completely recovered after 4-6 months. Conclusion Modified orbitozygomatic approach is a simple technology which can shorten operation time and obtain more surgical exposure scope by removing more bone structure.

关 键 词：手术入路 前交通动脉瘤 颅眶沟神经鞘瘤 

分 类 号：R739.41[医药卫生—肿瘤]