Mourier K L, Cophignon J, D'Hermies F, Clay C, Lot G, George B
Department of the Nervous System Diseases, Lariboisière Hospital, Paris.
Minim Invasive Neurosurg. 1994 Sep;37(1):9-11. doi: 10.1055/s-2008-1053441.
The conventional lateral approach to the orbit (Krönlein) does not allow a satisfactory view of the superior part of the orbit and the operative field is rather narrow. Therefore, large tumors which have developed not only laterally but also superiorly are usually approached transcranially. The craniotomy and exposure of the dura may be avoided when the tumor does not extend too far posteriorly and medially, by turning a larger orbital bone flap than the Krönlein's one. This technique was described by Nakamura as "type I orbitotomy" and can be referred to as a superolateral approach. After a bicoronal skin incision, a free orbital bone flap is cut. It includes the lateral orbital rim, a large external part of the superior orbital rim, and the lateral orbital wall. From 1985 to 1990 this approach was performed on 23 patients presenting with lacrimal gland tumors in 14 cases (11 pleomorphic adenomas, 2 adenoid cystic carcinomas, 1 adenocarcinoma), schwannomas in 2 cases, dermoid cyst in 1 case, hydatic cyst in 1 case, cavernous hemangiomas in 2 cases, inflammatory pseudotumor in 1 case, and mucoceles in 2 cases. This superolateral approach provides a wider exposure to the superolateral orbit than the classical Krönlein's approach and avoids the drawbacks of a craniotomy. A direct incision through the eyebrow can be used for bald people or for patients in poor condition.
传统的眼眶外侧入路（克伦莱因入路）无法充分观察眼眶上部，手术视野相当狭窄。因此，不仅向外侧生长而且向上方生长的大型肿瘤通常采用经颅入路。当肿瘤向后内侧延伸不太远时，通过翻转比克伦莱因骨瓣更大的眼眶骨瓣，可以避免开颅和硬脑膜暴露。这种技术被中村描述为“Ⅰ型眼眶切开术”，可称为超外侧入路。在冠状皮肤双切口后，切取一块游离眼眶骨瓣。它包括眶外侧缘、眶上缘的大部分外侧部分以及眶外侧壁。1985年至1990年，对23例患者采用了这种入路，其中14例为泪腺肿瘤（11例多形性腺瘤、2例腺样囊性癌、1例腺癌），2例为神经鞘瘤，1例为皮样囊肿，1例为包虫囊肿，2例为海绵状血管瘤，1例为炎性假瘤，2例为黏液囊肿。与经典的克伦莱因入路相比，这种超外侧入路能更广泛地暴露眶外侧上部，避免了开颅的缺点。对于秃顶患者或身体状况较差的患者，可以采用直接经眉切口。
