He Haiyong, Li Wensheng, Liang Chaofeng, Luo Lun, Hou Bo, Yang Huasheng, Guo Ying
Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Eye Tumor and Orbital disease, Zhongshan Ophthalmic Center (ZOC) of Sun Yat-Sen University, Guangzhou, China.
World Neurosurg. 2018 Jun;114:e631-e640. doi: 10.1016/j.wneu.2018.03.043. Epub 2018 Mar 13.
A pterional-orbital or subfrontal-orbital approach is recommended as a surgical treatment in cranio-orbital lesions. We describe a less invasive approach through an eyebrow incision combined supraorbital minicraniotomy and orbital osteotomy for treating some selected cranio-orbital lesions.
Sixteen patients with different cranio-orbital lesions were treated using this less invasive approach. Postoperative outcomes were evaluated to shed light on specific parameters related to this approach.
The 16 patients with cranio-orbital lesions underwent 17 operations. A total resection was achieved in 11 lesions. All the patients were followed up for 3-54 months. Postoperative proptosis improved in all cases. Five cases of visual impairment were improved, but 4 patients with blindness did not recover. One patient with bitemporal hemianopia recovered. Three patients with ocular dyskinesia did not recover. Two patients had transient cranial nerve III palsy, and 2 patients had cranial nerve VI palsy. One had delayed hydrocephalus. One died 1 year later as a result of pulmonary metastases. One recurred and the patient underwent a second operation. All the patients had a modified Rankin Scale score ≤1 at 12 weeks follow-up.
Some selected cranio-orbital lesions can be treated through a supraorbital eyebrow approach with orbital osteotomy. The presence of retro-ocular fat allows the orbital lesions to be classified as a lesion of the intraretro-ocular or extraretro-ocular fat. It is safe to resect the lesion of extraretro-ocular fat from the retro-ocular fat interface. However, the lesion with optic nerve and extraocular muscles involved should be removed from the intermuscular septae.
翼点-眶部或额下-眶部入路被推荐用于颅眶病变的手术治疗。我们描述了一种通过眉部切口联合眶上微创颅骨切开术和眶骨切开术的微创方法，用于治疗一些特定的颅眶病变。
16例患有不同颅眶病变的患者采用这种微创方法进行治疗。对术后结果进行评估，以阐明与该方法相关的具体参数。
16例颅眶病变患者接受了17次手术。11个病变实现了全切。所有患者均随访3至54个月。所有病例术后眼球突出均有改善。5例视力障碍有所改善，但4例失明患者未恢复。1例双颞侧偏盲患者恢复。3例眼球运动障碍患者未恢复。2例患者出现短暂性动眼神经麻痹，2例患者出现展神经麻痹。1例出现迟发性脑积水。1例患者1年后因肺转移死亡。1例复发，患者接受了二次手术。所有患者在随访12周时改良Rankin量表评分均≤1分。
一些特定的颅眶病变可通过眶上眉部入路联合眶骨切开术进行治疗。眶后脂肪的存在使眶部病变可分为眶后脂肪内或眶后脂肪外病变。从眶后脂肪界面切除眶后脂肪外病变是安全的。然而，累及视神经和眼外肌的病变应从肌间隔中切除。
