经翼点及额下入路开眶术治疗颅眶沟通性肿瘤分析  

Clinical analysis of transcranial orbitotomy by sub frontal or pterion approach on cranio-orbital tumors

作　　者：简天明[1] 唐东润[1] 王嵩[1,2] 吴桐[1] 赵亮[1] 孙丰源[1] 

机构地区：[1]天津市第一中心医院眼科,300192 [2]天津市第一中心医院神经外科

出　　处：《中国实用眼科杂志》2015年第11期1295-1299,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的分析13例经颅开眶手术治疗的颅眶沟通性肿瘤的病变位置和手术入路，探讨该手术入路的临床价值。方法对2009年12月至2013年12月，在天津市第一中心医院眼科经翼点入路或经额下入路开眶治疗的13例颅眶沟通性肿瘤患者的临床资料，据肿瘤的位置、形态、边界、质地、颅眶沟通通路和浸润范围，选择手术入路，并观察手术效果。结果经额下入路开眶7例；经翼点入路开眶6例，其中1例行眶内容剜除术和硬膜内肿瘤摘除术。肿瘤暴露充分，3例肿瘤整体摘除，10例肿瘤可分块摘除或刮除。眼球突出度平均降低5mm，最小降低2mm，最大降低15mm。12例眼球运动障碍者改善9例，无变化3例。并发症出现眼肌麻痹1例，完全性上睑下垂3例，瞳孔散大1例，无视力丧失及脑脊液漏。术后随访7例，失访6例。2例转移癌患者因全身转移死亡，1例神经鞘瘤及1例脑膜瘤术后1年肿瘤复发，分别再次手术治疗及伽马刀治疗。其余病例CT或MRI检查未发现肿瘤复发。结论经颅开眶手术可有效摘除颅眶沟通性肿瘤，正确手术入路的选择有利于充分暴露和手术操作。熟悉相关解剖结构及熟练的手术技巧可提高手术效果，减少严重并发症。Objective To investigate the surgical approach through transcranial orbitotomy for re- moval of cranio-orbital tumors, and to evaluate the clinical value of the surgical approach. Meth- ods A retrospective study was done on 13 patients with cranio-orbital tumors. According to the tu- mors＇ location, shape, boundary and invasion on the images, pterion approach, subfrontal approach for transcranial orbitotomy was performed by the cooperation between ophthalmologists and nettrosur- geons. The results of surgical treatment were evaluated by routinely follow-up. Results Operative approach： Subfrontal approach 7 cases; Pterion approach 6 cases, including 1 case combined with evisceration of orbit. Tumors were en bloc resection in 3 cases, block resection or curettage in 10 cases. Postoperatively, the mean reduction in exophthalmos was 5ram, maximum reduction was llmm, minimum reduction was 2ram. Ocular movement restriction were made better in 9/12 pa- tients, no change in 3/12 patients. Ophthalmoplegia occurred in 1 ease, complete ptosis occurred in 3 cases, mydriasis occurred in 1 case, no vision loss or cerebrospinal rhinorrhea. Seven cases were followed up, including 2 cases of metastatic carcinoma dead due to systemic metastasis, 1 case of schwannoma and 1 case of meningioma recurred, other cases were not found recurrence. Conclu- sions Cranio-orbital tumors can be removed effectively through transcranial orbitotomy, while opera- tive approach is convenient to the surgical procedure and can offer better exposure. Familiar with the tumors＇ location, adhesion, invasion and the skilled surgical techniques can improve the results and reduce serious complications.

关 键 词：颅眶沟通性肿瘤 手术入路 经颅开眶 手术效果 

分 类 号：R739.41[医药卫生—肿瘤]