经颅显微外科切除鞍区肿瘤临床资料分析和手术入路的选择

目的：总结经颅显微外科切除鞍区肿瘤的经验，探讨经颅切除鞍区肿瘤手术入路的选择。方法：回顾分析南通大学附属医院神经外科自2012年5月-2014年3月手术的鞍区肿瘤80例（脑膜瘤56例、垂体瘤12例、颅咽管瘤9例、皮样囊肿2例、神经内分泌源恶性肿瘤1例）的临床资料；手术入路包括翼点入路、额下入路和额外侧入路，肿瘤采用显微外科技术切除。分析全切除率、手术效果和并发症发生的情况。结果：采用翼点入路者50例，全切除率为66.0%；采用额下入路者16例，全切除率为75.0%；采用额外侧入路者14例，全切除率为71.4%。结论：显微手术是治疗鞍区肿瘤的主要手段，选择手术入路时应根据肿瘤的大小、生长方式以及肿瘤和周围重要结构的关系，遵循最优化和个体化原则，结合手术者的经验来决定。

The choice of transcranial microsurgery approaches for sellar region tumors and the clinical data analysis

Objective： To summarize the operation experience of transcranial microsurgery for sellar region tumors and ana-lyze the effect of different approaches in surgery. Methods： A retrospective analysis was made on 80cases of sellar region tu-mor operated from May 2012 to March 2014 in department of neurosurgery of the Affiliated Hospital of Nantong University which all removed by using microsurgical technique with three different surgical approach（trans-pterional, trans-subfronta, and trans-frontal lateral approach） , including 56 cases of meningiomas, 12 cases of pituitary adenoma, 9 cases of cranio-pharyngioma, 2 cases of dermoid cyst, and 1cases of neuroendocrine tumor. The removal rate, surgery effect and complica-tions were analyzed. Results： Trans-pterional approach were adopted in 50 cases and the tumor total resection rate was 66.0%;trans-subfrontal approach were adopted in 16 cases and the tumor total resection rate was 75.0%;trans-frontal lateral approach were adopted in 14 cases and the tumor total resection rate was 71.4%. Conclusion：Microscopic surgery is the main way of remove sellar region tumors. The surgical approach should be chosed following the principle of individual and opti-mization. The choice should be made according to the growth pattern of tumor, the tumor size, the relationship between tumor and surrounding structures, and the habit of surgeon.