微侵袭经眼睑入路手术治疗前中颅底脑膜瘤的初步探讨  

Trans-eyelid Approach to Resect Meningiomas of Anterior and Middle Cranial Base— A Preliminary Minimal Invasive Approach Study at Shanghai Huashan Hospital

作　　者：谢清[1,2,3] 汪戴军[1,2,3] 孙莉[4] 钟平[1,2,3] 郑名哲[1,2,3] 汤海亮[1,2,3] 朱宏达[1,2,3] 陈衔城[1,2,3] 周良辅[1,2,3] 宫晔[1,2,3] 

机构地区：[1]复旦大学附属华山医院神经外科,200040 [2]上海市神经外科临床医学中心,200040 [3]复旦大学上海医学院神经外科学系,200032 [4]复旦大学附属华山医院眼科,200040

出　　处：《中国临床神经科学》2014年第3期290-295,共6页Chinese Journal of Clinical Neurosciences

基　　金：国家自然科学基金课题(编号:12JC1401800);上海市科委基金课题(编号:NSFC-81372707)

摘　　要：目的探讨经眼睑入路切除部分累及中颅底肿瘤的微侵袭手术方式。方法在5例尸头解剖基础上,按照文献描述熟悉相关解剖关系。在改良部分入路方式后,采用经眼睑入路微侵袭手术方式对3例前中颅底脑膜瘤患者进行治疗。部分新的手术改进包括:①将切口略下移,呈类似双重睑手术切口;②皮下游离骨膜和颞肌筋膜瓣,以修补和重建颅底;③利用神经内镜和虚拟现实技术等辅助技术,进行多技术融合手术。结果 3例脑膜瘤患者手术均达到肿瘤全切除。其中1例为鞍结节脑膜瘤,1例为侵犯眼眶的蝶骨嵴脑膜瘤,1例为蝶骨嵴内侧型脑膜瘤。3例患者随访超过1年,手术效果良好,无肿瘤复发,术后恢复好。1例患者因肿瘤侵犯眼眶,后遗有眶尖综合征。结论经眼睑入路是一种安全的手术入路,适用于中小型蝶骨嵴内侧型脑膜瘤治疗,部分累及前、中颅底的肿瘤,可以达到常规翼点入路手术效果,同时减少手术创伤并取得良好的外观。Aim Transpalpebral or trans-eyelid approach is a modified tans-orbital access to the anterior cranial fossa.Previous reports mainly treated lesions of anterior cranial base.Our study from cadaveric anatomy to clinical operations with some revisions was described,which is also suitable for some tumors of middle cranial base.Methods After studying cadavers,assisted by an experienced ophthalmologist for incisions,3 female patients were treated via this approach：one with sphenoidal wing meningioma invading into orbit,one with sellae tuberculum meningioma,and the other with medial sphenoidal wing meningioma.Results There were some differences of exposure between trans-orbital and trans-eyelid approaches.Several revisions were made on the previously reported approaches：① Moving the incision a little lower to the edge of the eyelid,which resembles the double-eyelid incision.② Dissecting more periosteum tissue in case of repairing the opened frontal sinus and reconstruction of the skull base.Neuroendoscopic-assisted technique was applied to the study,and VR technique was also used to help design and practice operations.3 patients were treated by this approach.All tumors were totally resected,and Simpson Grade Ⅰ were achieved in 2 meningioma cases.Complications included mild stroke and orbital apex syndrome because of tumor invasion.No cerebrospinal fluid had leakage.Excellent cosmetic outcome was accomplished in 3 patients.Conclusion Transpalpebral or trans-eyelid approach is more suitable for lesions situated around sphenoidal wings within 2 cm range,especially lesions invading cranio-orbital communicating region,anterior and lateral to the internal carotid artery.Comparing to trans-orbital frontal mini-craniotomy,this approach may show that lesion is more lateral to the temporal lobe.We propose that this approach should be named as trans-eyelid pterional approach.This is a safe and minimally invasive approach,with excellent cosmetic results.

关 键 词：颅底外科 眼睑入路 微侵袭手术 脑膜瘤 

分 类 号：R651.11[医药卫生—外科学]