前床突磨除术在鞍区肿瘤和颈内动脉眼段/床突上段动脉瘤中的应用  

Application of anterior clinoid grinding in sellar region tumors and ophthalmic/superior clinoid process aneurysms of internal carotid artery

作　　者：张杰 周忠清[1] 石祥恩[2] 杨扬 倪伟民 于在涛 孙玉明[1] 刘方军[1] 钱海[1] Zhang Jie;Zhou Zhongqing;Shi Xiang′en;Yang Yang;Ni Weimin;Yu Zaitao;Sun Yuming;Liu Fangjun;Qian Hai(Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University,Beijing 100093,China;Department of Neurosurgery,Fuxing Hospital Affiliated to Capital Medical University,Beijing 100045,China;Department of Neurosurgery,the First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,China)

机构地区：[1]首都医科大学三博脑科医院神经外科,北京100093 [2]首都医科大学附属复兴医院神经外科,北京100045 [3]锦州医科大学附属第一医院神经外科,锦州121000

出　　处：《中国医师进修杂志》2022年第8期681-685,共5页Chinese Journal of Postgraduates of Medicine

基　　金：北京市自然科学基金重点项目(7161005)。

摘　　要：目的评价前床突磨除术在处理颈内动脉眼段/床突上段动脉瘤及鞍区肿瘤的临床治疗效果。方法回顾性分析首都医科大学三博脑科医院2015年1月至2021年7月行前床突磨除术16例患者的临床资料,其中复发颅咽管瘤患者1例,复发垂体腺瘤患者1例,动脉瘤患者13例,鞍上颗粒细胞瘤合并右侧颈内动脉眼段动脉瘤患者1例。使用患者改良Rankin量表(mRS)对患者出院时及中远期情况进行评价。结果16例患者进行了前床突磨除手术,出院时及最近一次随访显示患者mRS评分均在0~2分。共处理了15枚动脉瘤,术后均未出现视力下降或视野缺损症状。所有患者均未发生脑脊液漏。结论前床突磨除术可有效充分游离及移位视神经、颈内动脉,可在直视下观察垂体柄下端及颈内动脉眼段/床突上段瘤颈,是鞍区病变处理的重要辅助术式之一。Objective To evaluate the clinical effect of anterior clinoid process grinding in the treatment of ophthalmic/superior clinoid process aneurysms and sellar tumors.Methods The clinical data of 16 patients who underwent anterior clinoid process grinding in Sanbo Brain Hospital,Capital Medical University from January 2015 to July 2021 were analyzed retrospectively.There were 1 patient with recurrent craniopharyngioma,1 patient with recurrent pituitary adenoma,13 patients with aneurysms,and 1 patient with suprasellar granulosa cell tumor combined with ophthalmic aneurysm of right internal carotid artery.The Modified Rankin Scale(mRS)score was used to evaluate the situation at discharge and in the medium-and-long term.Results Sixteen patients underwent anterior clinoidprocess grinding.At discharge and the latest follow-up,the mRS scores of the patients were 0-2.A total of 15 aneurysms were treated,and there were no symptoms of visual loss or visual field defect after operation.No cerebrospinal fluid leakage occurred in all patients.Conclusions The grinding of anterior clinoid process can effectively and fully stretch the optic nerve and internal carotid artery,and can observe the tumor neck at the lower end of pituitary stalk and the ocular segment/superior clinoid process of internal carotid artery under direct vision.It is one of the important auxiliary methods for the treatment of sellar lesions.

关 键 词：鞍区肿瘤 前床突磨除 动脉瘤 颈内动脉 

分 类 号：R739.41[医药卫生—肿瘤]