锁孔入路开颅手术(附106例报告)  

A craniotomy via keyhole approach (a report of 106 cases)

作　　者：刘运生[1] 刘景平[1] 王君宇[1] 罗端午[1] 陈立华[1] 姜维喜[1] 刘志雄[1] 陈凌[1] 候永宏[1] 袁贤瑞[1] 曹美鸿[1] 

机构地区：[1]中南大学湘雅医院神经外科,长沙410008

出　　处：《中华神经外科疾病研究杂志》2002年第1期14-17,共4页Chinese Journal of Neurosurgical Disease Research

基　　金：卫生部科研基金资助课题(98-1-113)

摘　　要：目的 评价用锁孔入路开颅术显微切除垂体腺瘤、颅咽管瘤、鞍结节脑膜瘤、脑胶质瘤、听神经瘤及直视下夹闭后交通动脉瘤、前交通动脉瘤的效果及安全性。方法 对垂体腺瘤、颅咽管瘤、脑膜瘤、后交通动脉瘤及前交通动脉瘤于眶上外侧,右颞叶胶质瘤于右颞,听神经瘤于耳后,分别作一直径2.5cm骨瓣,显微镜下切除肿瘤或直视下夹闭动脉瘤。结果 垂体腺瘤77例中65例达到全切除,12例为次全切除;颅咽管瘤11例、鞍结节脑膜瘤6例、胶质瘤1例及听神经瘤7例,均予全切;4例颅内动脉瘤均夹闭成功。所有患者恢复良好,未发生与手术入路有关的并发症。结论 采用锁孔入路,能够安全切除直径在55mm以下的大型、巨大型垂体腺瘤,以及30～70mm的颅咽管瘤、鞍结节脑膜瘤、听神经瘤,并可直视下夹闭前、后交通动脉瘤。Objective The goal of this study is to evaluate the efficacy and safety of a microsurgical craniotomy via keyhole approach for large and giant pituitary adenomas, craniopharyngiomas, tuberculum sellar meningiomas, gliomas, acoustic neuromas, posterior communicating artery aneurysms, and anterior communicating artery aneurysms. Methods A supraorbital keyhole approach was performed for large and giant pituitary adenomas, craniopharyngiomas, tuberculum sellar meningiomas, the posterior communicating artery aneurysms, and anterior communicating artery aneurysms. A temporal keyhole approach was performed for gliomas in temporal lobe. A posterior auricular keyhole approach was performed for acoustic neuromas. The diameter of the bone flap was 25 mm. The tumors and aneurysms were treated with microsurgical operation. Results Among 77 cases of large and giant pituitary adenoma, 65 were totally removed, 12 were subtotally removed. And 11 cases of craniopharyngioma, 6 cases of tuberculum sellar meningioma, 1 case of glioma, 7 cases of acoustic neuroma were all totally removed under microscope. Four cases of aneurysm were all clipped safely. All patients recovered very well after operation. None of the complications related to the surgical approach could be seen. Conclusion A craniotomy via keyhole approach can remove the pituitary adenoma, craniopharyngioma, tuberculum sellar meningioma, glioma completely, and can clip the posterior communicating artery aneurysm and the anterior communicating artery aneurysm safely.

关 键 词：锁孔入路 开颅手术 脑肿瘤 脑动脉瘤 治疗 

分 类 号：R739.410.5[医药卫生—肿瘤]