经颅入路切除眶内或颅-眶沟通性肿物

目的 探讨经颅入路切除眶内或颅-眶沟通性肿瘤的手术方法。方法 均采用双侧额部发际内冠状切口，根据肿瘤大小、占据眶内的部位以及是否有颅内侵犯，调整皮肤切口的长短，选择合适的开颅骨瓣：单侧额部入路、经额经眶上缘入路或经额经颧经眶上缘入路。对单纯眶内肿瘤，采用硬膜外入路；对眶-颅沟通性肿瘤，先经硬膜内处理肿瘤的颅内部分，然后打开眶顶和（或）眶外侧壁切除眶内肿瘤。结果 全切除26例，部分切除3例，无手术死亡。术后除1例有动眼神经麻痹，另2例遗患侧眼失明外，无其它手术并发症。结论 经颅入切除眶内或颅-眶沟通性肿瘤时，选择合适的开颅骨瓣而使肿瘤得以充分显露是手术成功的基础；采用显微外科技术是提高全切除率、减少并发症的关键。

Transcranial approaches for orbital tumor and craniorbital communicating dumbbell tumor

Objective To report our surgical experience for orbital tumor or craniorbital communicating dumbbell tumors. Methods 29 patients with orbital tumors or craniorbital communicating dumbbell tumors treated by transcranial approach during recennt decade were retropectively analysed. We made a bicoronal skin incision and chose one of three transcranial approaches to orbit, including ispilateral subfrontal approach, transorbitorimal subfrontal approach and transorbitorimal subfrontal transzygomal approach, according to the size and location of the orbital tumor and whether it existed intracranial extension. If the tumor was confined to the orbit, an epidural approach was used. For craniorbital communicating dumbbell tumors, we precedently removed the intracranial part of the tumor and then performed the orbital unroofing and/or lateral orbitotomy and resected the intraorbital part of the tumor. Results Total removal was achieved in 26 cases and subtotal removal in 3 cases. There was no operative death. Postoperatively, permanent oculomotor nerve palsy was found in 1 case and homolateral blindness occurred in 2 cases. There was no other complication.Conclusions We consider that adequate exposure of the tumor resulting from a suitable surgical approach is the basis of surgical success and that microsurgical technique is the key to increasing total removal rate and reducing surgical complication rate in treating orbital tumors and craniorbital communicating dumbbell tumors.