Department of Neurosurgery, The Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2013 Dec;80(6):864-71. doi: 10.1016/j.wneu.2012.06.027. Epub 2012 Jun 19.
To report an initial experience with a medial transorbital approach to the midline skull base performed via a transconjunctival incision.
The authors retrospectively reviewed their clinical experience with this approach in the management of benign cranial base pathology. Preoperative imaging, intraoperative records, hospitalization charts, and postoperative records were reviewed for relevant data.
During the period 2009-2011, six patients underwent a transconjunctival craniotomy performed by a neurosurgeon and otolaryngologist-head and neck surgeon working together. The indications for surgery were esthesioneuroblastoma in one patient, juvenile angiofibroma in one patient, Paget disease in one patient, and recalcitrant cerebrospinal fluid leaks in three patients. Three patients had prior cranial base surgery (either open craniotomy or an endonasal approach) done at another institution. The mean length of stay was 3.8 days; mean follow-up was 6 months. Surgery was considered successful in all cases (negative margins or no leak recurrence); diplopia was noted in one patient postoperatively.
The transconjunctival medial orbital craniectomy provides a minimally invasive keyhole approach to lesions located anteriorly along the anterior cranial fossa that are in the midline with lateral extension over the orbital roof. Based on our initial experience with this technique, the working space afforded limits complex surgical dissection; this approach is primarily well suited for less extensive pathology.
报告经结膜切口经眶内侧入路中线颅底的初步经验。
作者回顾性分析了他们在良性颅底病变治疗中应用该入路的临床经验。对术前影像学、术中记录、住院记录和术后记录进行了回顾，以获取相关数据。
2009 年至 2011 年期间，6 名患者接受了由神经外科医生和耳鼻喉科-头颈外科医生共同进行的经结膜颅切开术。手术指征为 1 例嗅神经母细胞瘤、1 例青少年血管纤维瘤、1 例 Pagets 病和 3 例难治性脑脊液漏。3 名患者曾在另一家机构接受过颅底手术（开颅手术或经鼻入路）。平均住院时间为 3.8 天；平均随访时间为 6 个月。所有病例手术均成功（切缘阴性或无漏复发）；1 例患者术后出现复视。
经结膜内侧眶颅切开术为中线颅底前部、前颅窝沿中线延伸至眶顶外侧的病变提供了微创锁孔入路。根据我们对该技术的初步经验，提供的工作空间限制了复杂的手术解剖；该方法主要适用于病变范围较小的情况。
