侵及海绵窦的眶颅沟通性神经鞘瘤的显微手术治疗

目的通过总结显微手术切除侵及海绵窦的眶颅沟通性神经鞘瘤的经验，探讨沟通眶颅的神经鞘瘤的手术方法，以提高手术全切率及减少并发症。方法回顾性分析2009年1月至2011年12月采用眶-翼点入路硬脑膜外显微手术切除的侵及海绵窦的眶颅沟通性神经鞘瘤24例的临床资料，其中神经内镜辅助手术5例，并对该类肿瘤的特点及手术要点进行分析。结果肿瘤全切除20例，次全切除4例，肿瘤全切率为83．3％，无死亡病例。术后新出现10例眼球运动障碍；3个月后6例完全恢复，2例不全麻痹，2例无变化。1例病人术后2周出现溃疡性角膜炎，治疗后未愈。1例病人术后失明。4例次全切的患者术后2周行1刀治疗。术后随访3～18个月，平均8个月，复查MRI示全切病例无肿瘤复发，次全切病例未见残余肿瘤明显增大。结论眶颅沟通性神经鞘瘤从眶内通过眶上裂侵犯眶尖区及海绵窦，经眶-翼点入路硬脑膜外手术全切率高，并发症少，效果满意，是对侵及海绵窦的眶颅沟通性神经鞘瘤较好的手术方式。

Microsurgery for orbitocranial neurilemomas invading cavernous sinuses (report of 24 cases)

Objective To explore the surgical methods to treat the orbitocranial neurilemoma invading the cavernous sinus. Methods The clinical data of 24 patients with orbitocranial neurilemomas invading the cavernous sinuses, who underwent epidural microsurgery via the orbito-pterional approach in our department from January, 2009 to December 2011, were analyzed retrospectively. Endoscope-assisted microsurgery was performed in 5 patients. Result Of 24 patients, 20 received the total resection of the tumors and 4 subtotal resection. No patients died. The postoperative complications included ocular motor disorder in 10 patients, of whom, 6 were recovered 3 months after the surgery and 4 not, blindness in 1 patient and ulcerative keratitis in 1 patient which was cured. Four patients with residual tumors received ＂,/-knife treatment 2 weeks after the surgery. The following-up from 3 to 18 months （mean, 8 months） showed that on MRI, no tumors recurred in 20 patients undergoing the total resection of the tumors and the residual tumors were unchanged in 4 patients undergoing the subtotal resection of the tumors. Conclusions The epidural microsurgery via the orbito-pterional approach is a good method to treat the orbitocranial neurilemoma invading the cavernous sinus because it produces fewer complications and its curative effect on the tumor is good.