神经外科医生和眼科医生组成的跨学科团队经翼点入路进行经颅手术切除颅眶肿瘤。
Transcranial surgery through pterional approach for removal of cranio-orbital tumors by an interdisciplinary team of nurosurgeons and ophthalmologists.
作者信息
Liu Yan, Ma Jiang-Rong, Xu Xue-Liang
机构信息
Departmemt of Ophthalmology, Xiangya Hospital, Central South University. Changsha 410008, Hunan Province, China.
出版信息
Int J Ophthalmol. 2012;5(2):212-6. doi: 10.3980/j.issn.2222-3959.2012.02.19. Epub 2012 Apr 18.
AIM
To investigate the specialty of transcranial surgery through pterional approach for removal of cranio-orbital tumors, introduce the ophthalmological experiences of entering the orbit to reduce the incidence rate of associated complications of this operation.
METHODS
We performed a retrospective analysis of a series of 37 cases involving patients who underwent transcranial surgery through pterional approach for treatment of cranio-orbital tumors in our department in the past 8 years. Pterion approach craniotomy was performed to all patients. After removing tumors in the skull by the neurosurgeon, ophthalmologist removed tumors in orbit. We took measures below to decrease complications, including grounding optic canal through an abrasive drilling when necessary, hanging various extraocular muscles to be exposed for protection, refrigerating by refrigeration heads to remove tumors, at last sewing up orbit septum after surgery.
RESULTS
Tumors were removed completely in 32 cases, and incomplete in 5 cases due to extensive invasion into the cavernous sinus or sphenoid sinus. Of all the cases, benign tumors were demonstrated in 28 cases (75.6%, 28/37) and malignant in 9(24.3%, 9/37). The most common lesion type was meningioma in 11 cases (29.7%, 11/37). Extraocular muscles (EOM) impairment, occurring in 21 cases (56.7%, 21/37), was the most frequent postoperative complication. The most serious consequence was vision loss occurred in 4 cases (10.8%, 4/37). Other complications, such as 11 cases of transient blepharoptosis 29.7% (11/37), 5 cases of mydriasis in 13.5% (5/7); 2 cases of cerebrospinal rhinorrhea in 5.4% (2/37).
CONCLUSION
Cranio-orbital tumors can be removed completely using transcranial approach, and the pterional approach offers excellent exposure. Cooperation of interdisciplinary team of neurosurgeons and ophthalmologists conduces to full use of respective professional advantages. The experience of ophthalmic operation technology can decrease occurrence of ocular complications after surgery.
目的
探讨经翼点入路开颅手术切除颅眶肿瘤的特点，介绍经眶手术的眼科经验，以降低该手术相关并发症的发生率。
方法
回顾性分析我科过去8年中采用经翼点入路开颅手术治疗颅眶肿瘤的37例患者。所有患者均行翼点入路开颅术。神经外科医生切除颅内肿瘤后，眼科医生切除眶内肿瘤。我们采取了以下措施来减少并发症，包括必要时通过磨钻磨开视神经管，悬吊暴露的各条眼外肌进行保护，用冷冻头冷冻切除肿瘤，最后术后缝合眶隔。
结果
32例肿瘤完全切除，5例因广泛侵犯海绵窦或蝶窦而切除不完全。所有病例中，良性肿瘤28例（75.6%，28/37），恶性肿瘤9例（24.3%，9/37）。最常见的病变类型是脑膜瘤11例（29.7%，11/37）。眼外肌（EOM）损伤是最常见的术后并发症，发生在21例（56.7%，21/37）。最严重的后果是4例（10.8%，4/37）视力丧失。其他并发症包括11例（29.7%，11/37）短暂性上睑下垂，5例（13.5%，5/7）瞳孔散大；2例（5.4%，2/37）脑脊液鼻漏。
结论
经颅入路可完全切除颅眶肿瘤，翼点入路暴露良好。神经外科医生和眼科医生的跨学科团队合作有助于充分发挥各自的专业优势。眼科手术技术经验可降低术后眼部并发症的发生率。
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