El Shafei Hassan I
Department of Neurosurgery, Manial University Hospital, Cairo University, Cairo, Egypt.
Pediatr Neurosurg. 2011;47(4):248-53. doi: 10.1159/000335399. Epub 2012 Feb 3.
Various approaches to lesions in the anterior cranial fossa and sellar region have been described by different authors under various names which describe the extent of craniotomies. The aims of this study were to describe and retrospectively analyze and evaluate the anterolateral mini fronto-orbito-zygomatic (MFOZ) approach via an eyebrow incision in treating pediatric pathologies, especially those related to the sellar region.
Between January 2003 and December 2008, 18 patients with lesions in the sellar region or the anterior corridor leading to it were operated upon via the same approach. There were 10 males and 8 females. The age ranged between 11 months and 15 years (mean 7.9 years). The pathologies were craniopharyngiomas in 6 cases, hypothalamic and chiasmal pilocytic astrocytoma in 7 and 5 miscellaneous cases including 2 pituitary adenomas, 1 extradural hematoma, hypothalamic hamartoma and 1 arachnoid cyst in the retrosellar and prepontine area. Surgery was performed from the right side in 15 cases and from the left in 3 cases.
Total resection was achieved in 9 cases (50%), subtotal resection in 4 cases (22%), and partial resection in 5 cases (28%). Complications related to the approach like CSF rhinorrhea, supraorbital hypoesthesia and loss of upward elevation of the eyebrow were temporary. There was no mortality in this study and no significant added morbidities related to the approach. The approach has the advantages of the small cosmetic eyebrow incision and the skull base trajectory, thus reducing brain retraction and achieving the desired exposure with good outcome.
The MFOZ craniotomy using an eyebrow incision in pediatric patients is safe, effective, and both suitable and convenient for treating lesions especially at the sellar region.
不同作者用各种描述开颅范围的名称描述了处理前颅窝和鞍区病变的多种方法。本研究的目的是描述、回顾性分析和评估经眉弓切口的前外侧微型额眶颧（MFOZ）入路治疗儿童疾病，尤其是与鞍区相关的疾病。
2003年1月至2008年12月期间，18例鞍区或通向鞍区的前通道病变患者采用相同入路进行手术。其中男性10例，女性8例。年龄在11个月至15岁之间（平均7.9岁）。病变包括颅咽管瘤6例，下丘脑和视交叉毛细胞型星形细胞瘤7例，其他5例，包括2例垂体腺瘤、1例硬膜外血肿、下丘脑错构瘤和1例鞍后及脑桥前区蛛网膜囊肿。15例手术从右侧进行，3例从左侧进行。
9例（50%）实现全切，4例（22%）次全切，5例（28%）部分切除。与该入路相关的并发症如脑脊液鼻漏、眶上感觉减退和眉弓上抬丧失均为暂时性。本研究无死亡病例，且与该入路相关的额外并发症不显著。该入路具有眉弓小切口美观及颅底入路的优点，从而减少脑牵拉，并能获得理想的显露效果及良好预后。
小儿患者采用眉弓切口的MFOZ开颅术安全、有效，适用于且便于治疗尤其是鞍区的病变。
