眉弓入路切除颅眶沟通性病变的临床观察

目的 探讨颅眶沟通性病变经眉弓入路的手术方法及疗效.方法 回顾性分析我院2005年3月至2007年6月收治的21例颅眶沟通性病变患者的临床资料.对所有患者均经眉弓入路进行手术切除病变治疗,根据术前眼眶CT、MRI检查采取合适的手术切口及骨瓣.结果 本组21例中肿瘤全切除14例,近全切除6例,大部切除1例.术后一过性脑脊液鼻漏3例;上睑下垂8例,均于术后2～3个月恢复;额部皮肤麻木9例,其中眶上神经切断6例未能恢复.术后18例患者随访1～24个月,平均13个月.1例泪腺腺样囊性癌患者术后1.5年复发.结论 合适的经眉弓入路能够充分显露颅眶沟通性病变,手术安全,并发症少,符合微创原则;部分患者眶上神经损伤为其缺点.

Resection of cranio-orbital communicating lesions through eyebrow incision

Objective Introducing a modified supraorbital keyhole approach with eyebrow incision and its surgical outcomes for cranio-orbital communicating lesions. Methods The clinical data of 21 cases from Mar 2005 to Jun 2007 were retrospectively studied. Patients ages ranged from 22 to 73 years with 48.8 years in average. Eight patients were male, 13 were female. The chief compliants were progressive proptosis and loss of visual acuity. Based on the relation of lesion and the optic nerve, lesions were classified into four types: internal, lateral, middle and mixed. We used suitable eyebrow incision so a one-piece supraorbital craniotomy was made that incorporated the orbital rim and roof and the frontal process of the zygomatic bone. The orbital osteotomy facilitated the view of the anterior and middle cranial fossa through the operating microscope. Duration of follow up was 1 month to 2 years. Results Total tumor removal was achieved in 14 cases, subtotal removal in 4 cases, partial removal in 1 case. Postoperatively, temporal CSF leak was found in 3 cases; ptosis was found in 8 cases but all recovered within 3 months. Frontal numbness occurred in 9 cases and persisted in 6 cases. There was no operative death or other significant complication. Tumor recurred in 1 case. Conclusions Adequate orbital apex decompression and exposure of the cranio-orbital communicating lesions can be achieve from suitable eyebrow incision. This approach is relatively safe and with few complications, and is "minimal invasive". But supraorbital nerve injury in some patient is the drawback of this approach.