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眶上入路治疗前颅底和鞍旁病变：单中心经验见解

Supraorbital Approaches for Anterior Skull Base and Parasellar Lesions: Insights From a Single-Center Experience.

作者信息

Lee Han Gyul, Cho Sung Jin, Park Hye Ran, Seo Dongwook

机构信息

Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.

出版信息

Brain Tumor Res Treat. 2024 Jul;12(3):172-180. doi: 10.14791/btrt.2024.0026.

DOI:10.14791/btrt.2024.0026
PMID:39109618
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11306836/
Abstract

BACKGROUND

Modern neurosurgery has undergone significant evolution to include minimally invasive procedures, with the supraorbital approach (SOA) being a prime example. In this study, we aim to explore the surgical techniques and outcomes of this approach in the surgical treatment of frontal lobe, anterior skull base, and parasellar lesions.

METHODS

This study included 33 patients aged 36-83 years who underwent surgery using the SOA for lesions in the inferior frontal lobe, anterior skull base, and parasellar area between 2015 and 2024. There were 25 cases of meningioma, 2 cases of brain abscess, 2 cases of glioma, and one case each of craniopharyngioma, hemangioma, metastasis, and Rathke's cleft cyst. The medical data and follow-up results were retrospectively analyzed.

RESULTS

The mean size of lesion was 3.38±3.05 cm. The mean follow-up period was 48.8 months. Gross total resection was achieved in 25 patients (75.8%). There were no perioperative deaths, cases of cerebrospinal fluid rhinorrhea, or infections. Two cases of morbidity were reported as complications: one case of delayed intracerebral hemorrhage and one case of infarction due to vascular injury. All patients exhibited satisfactory cosmetic results.

CONCLUSION

In comparison to the conventional pterional approach, the SOA represents a safe and effective keyhole method for the removal of both extra-axial and intra-axial skull base tumors. This is particularly beneficial for lesions in the orbitofrontal region and parasellar area, as it allows for minimal disruption of normal brain parenchyma. Moreover, the SOA promotes a swift recovery and short hospital stay. Additionally, the SOA yields superior cosmetic results, including the prevention of temporalis muscle atrophy.

摘要

背景

现代神经外科手术已历经重大变革，纳入了微创手术，眶上入路（SOA）便是一个典型例子。在本研究中，我们旨在探讨该入路在额叶、前颅底和鞍旁病变手术治疗中的手术技巧及疗效。

方法

本研究纳入了33例年龄在36至83岁之间的患者，这些患者在2015年至2024年间接受了眶上入路手术，以治疗额叶下部、前颅底和鞍旁区域的病变。其中有25例脑膜瘤、2例脑脓肿、2例胶质瘤，颅咽管瘤、血管瘤、转移瘤和拉克氏囊肿各1例。对医疗数据和随访结果进行了回顾性分析。

结果

病变的平均大小为3.38±3.05厘米。平均随访期为48.8个月。25例患者（75.8%）实现了肿瘤全切除。无围手术期死亡、脑脊液鼻漏或感染病例。报告了2例并发症：1例迟发性脑出血和1例血管损伤导致的梗死。所有患者的美容效果均令人满意。

结论

与传统翼点入路相比，眶上入路是一种安全有效的锁孔手术方法，可用于切除轴外和轴内颅底肿瘤。这对于眶额区域和鞍旁区域的病变尤为有益，因为它对正常脑实质的破坏最小。此外，眶上入路促进快速康复且住院时间短。此外，眶上入路产生更好的美容效果，包括预防颞肌萎缩。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1587/11306836/d6d517fec9d7/btrt-12-172-g010.jpg
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