Jho H D
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Minim Invasive Neurosurg. 1997 Sep;40(3):91-7. doi: 10.1055/s-2008-1053424.
Utilizing the conceptual combination of brain protective skull base surgery and minimalism, a conventional frontal craniotomy for tumors in the subfrontal and parasellar regions is modified to an orbital roof craniotomy. Through a 4 to 5 centimeter (cm) long eyebrow incision an orbital roof craniotomy (measuring 2 cm by 3 cm), including the supraorbital arch, is made as a single piece bone flap. The orbital roof is opened up to the supraorbital fissure and to the optic canal by additional removal of the bone in the orbital roof. This will expose the globe and the orbitofrontal dura mater. When the dural incision is made at the orbital portion of the dura mater, the orbital contents are retracted by tack-up sutures. The tumor is removed utilizing the orbital space rather than the intracranial space. Brain retractors are not necessary and are not used to execute the tumor resection. This technique has been used in three patients with craniopharyngiomas, seven patients with meningiomas, and one patient with a subfrontal teratoma. Gross total resection was achieved in three patients with craniopharyngiomas and in five patients with subfrontal or parasellar meningiomas. Subtotal resection of the tumor was achieved in two patients with recurrent meningiomas and in the patient with a subfrontal teratoma. The surgeon's operating space through this exposure was sufficiently ample to achieve the goals of the operation. The direct eyebrow incision provides an additional vital working space with a width of more than 1 cm at the skull base by eliminating the scalp flap which a coronal incision employs. The surgical technique is described with a report of 11 cases.
利用脑保护颅底手术与微创理念的结合，将传统的用于额下和鞍旁区域肿瘤的额部开颅手术改良为眶顶开颅手术。通过一个4至5厘米长的眉弓切口制作一个眶顶开颅（尺寸为2厘米×3厘米），包括眶上弓，作为一块完整的骨瓣。通过额外去除眶顶的骨质，将眶顶打开至眶上裂和视神经管。这将暴露眼球和眶额硬脑膜。当在硬脑膜的眶部进行硬脑膜切开时，眶内容物通过缝线牵拉回缩。利用眶内空间而非颅内空间切除肿瘤。不需要脑牵开器，也不使用脑牵开器进行肿瘤切除。该技术已应用于3例颅咽管瘤患者、7例脑膜瘤患者和1例额下畸胎瘤患者。3例颅咽管瘤患者和5例额下或鞍旁脑膜瘤患者实现了肿瘤全切。2例复发性脑膜瘤患者和额下畸胎瘤患者实现了肿瘤次全切。通过这种暴露，外科医生的手术空间足够宽敞，能够实现手术目标。直接眉弓切口通过省去冠状切口所采用的头皮瓣，在颅底提供了一个宽度超过1厘米的额外重要工作空间。本文结合11例病例报告对该手术技术进行了描述。
