McLaughlin N, Ditzel Filho L F S, Shahlaie K, Solari D, Kassam A B, Kelly D F
Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA 90404, USA.
Minim Invasive Neurosurg. 2011 Aug;54(4):155-61. doi: 10.1055/s-0031-1284401. Epub 2011 Sep 15.
Suprasellar tumors can be removed through a variety of approaches including conventional frontotemporal craniotomies, the transsphenoidal route, or the supraorbital (SO) eyebrow craniotomy. Herein we assess the utility of the SO route for recurrent or residual suprasellar tumors previously treated by an alternative route.
A retrospective analysis of all consecutive patients who underwent an SO approach for removal of a recurrent/residual tumor was undertaken.
Between December 2007 and February 2010, 11 patients underwent an SO craniotomy for a recurrent or growing residual tuberculum sellae meningioma (n=7) or craniopharyngioma (n=4). All 11 patients had prior craniotomies, 5 had transsphenoidal surgery, 6 had radiation treatment, and 1 had chemotherapy. In the last 5 cases, the endoscope was used in addition to the microscope for intraoperative visualization. 3 patients underwent decompression of multicystic craniopharyngiomas and the remaining 8 patients had tumor debulking, all achieving 70% or more tumor removal. Of 9 patients with preoperative visual deterioration, 6 (67%) had improvement and no patient had visual worsening. No new adenohypophysis or neurohypophysis dysfunction was noted. One patient had a postoperative CSF leak requiring reoperation.
The SO approach should be considered as a safe and effective alternative route for recurrent or residual suprasellar tumors previously treated by conventional craniotomy or TS surgery. It typically offers a simplified trajectory that minimizes scar tissue from prior approaches and provides excellent access for optic apparatus decompression. Endoscopy is helpful to visualize hidden tumor remnants and maximize safe tumor removal.
鞍上肿瘤可通过多种入路切除，包括传统的额颞开颅术、经蝶窦入路或眶上（SO）眉弓开颅术。在此，我们评估SO入路在治疗先前经其他入路治疗过的复发性或残留性鞍上肿瘤中的应用价值。
对所有连续接受SO入路切除复发性/残留性肿瘤的患者进行回顾性分析。
2007年12月至2010年2月期间，11例患者接受了SO开颅术，以切除复发性或生长性残留的鞍结节脑膜瘤（n = 7）或颅咽管瘤（n = 4）。所有11例患者均曾接受过开颅手术，5例接受过经蝶窦手术，6例接受过放射治疗，1例接受过化疗。在最后5例病例中，术中除使用显微镜外还使用了内镜进行可视化操作。3例患者接受了多囊性颅咽管瘤减压手术，其余8例患者进行了肿瘤减瘤手术，所有患者的肿瘤切除率均达到70%或更高。9例术前视力减退的患者中,6例(67%)视力改善，无患者视力恶化。未发现新的腺垂体或神经垂体功能障碍。1例患者术后发生脑脊液漏，需要再次手术。
对于先前经传统开颅术或经蝶窦手术治疗过的复发性或残留性鞍上肿瘤，SO入路应被视为一种安全有效的替代入路。它通常提供一条简化的路径，可将先前入路产生的瘢痕组织降至最低，并为视神经装置减压提供良好的入路。内镜有助于观察隐藏的肿瘤残余，最大限度地安全切除肿瘤。
