经颅开眶治疗眶内突眼性肿瘤的改良方法

目的探讨经颅开眶摘除眶内肿瘤改良手术的可行性。方法1998年1月至2004年3月，我们共收治了8例眶内占位性病变患者。由双侧头皮冠状切口径路，将经颅开眶术的单块额眶骨瓣改为额、眶上缘眶上壁两块骨瓣的截骨方式。移开骨瓣后，分别探查颅内及眶内，术毕，复位眶上壁眶上缘及额骨骨瓣，用微型钛板钛钉作坚强固定。结果手术视野清晰，术区显露良好，术中发现眶内病变部位分别为球后外上方、球后及球后内上方。病种涉及泪腺癌、视神经鞘瘤、脑膜瘤、海绵状血管瘤。术中需输血者为4例。术后数日内3例发生复视，1例失明。经3～6个月随访3例复视消失，6例裸眼视力同术前，1例失明，1例视力下降。眼突出度与健侧相对称，额眶部外形良好，创口瘢痕隐蔽，无其它并发症。结论本术式经颅摘除眶内肿瘤是较为安全、显露良好的方法，手术操作更为容易，又能保持眶七壁颅前窝的完整性，减少了并发症的发生。

Modified transcranial orbitotomy for treating exophthalmic intraorbital tumor

ObjectiveTo study the feasibility of the modified osteotomy of transcranial orbitotomy in the treatment of intraorbital tumor. Methods We treated 8 patients with intraorbital tumor during six years. By the bicoronary incision, all cases underwent double bone flap osteotomy on the frontal bone: the superior orbital rim bone flap and roof flap instead of single fronto-orbital bone flap in the conventional transcranial orbitotomy. After removal of bone flaps, intracranial and intraorbital operation was performed. Then, two bone flaps were reduced respectively and fixated with titanic micro-plates and nails. At last, the scalp flap was sutured. Results The operative field was very well exposed. It was found that the retrobulbar tumor was located at the superolateral, median and superonasal area respectively, which was coincided with the preoperative CT and MRI. The tumor included adenocarcinoma of the lacrimal gland, neurinoma, meningioma, and cavernous hemangioma. Four patients had blood transfusion during the operation. No other postoperative complications happened except 3 cases of diplopia and one case of blindness. After 3 to 6 months follow up, diplopia of the 3 cases gradually disappeared. Of the 8 cases, 6 reached the same visual acuity as the preoperative state. One decreased visual acuity and one lost light perception. There was well-balanced fronto-orbital appearance and eyeball position compared with the healthy side in all cases. ConclusionsThis surgical method for the treatment of intraorbital tumor is safe with well-exposed operative field. It has advantages not only in simpleness and less trauma, but also in keeping orbital roof and anterior fossa intact and decreasing complications.