翼点眶上小骨窗开颅显微手术切除大型鞍区肿瘤

目的 探讨应用翼点眶上小骨窗入路显微手术冶疗大型鞍区肿瘤的临床效果。方法 21例大型鞍区肿瘤均采用经翼点皮切口眶上小骨窗入路进行开颅手术。皮瓣按翼点入路切开，但仅采用经眶上小骨窗开颅，骨窗呈椭圆形，最大直径仅为3．5～4．0cm，前部尽量靠近颅前窝底，应用显微外科技术将鞍区肿瘤切除。结果 取得显微镜下全切除18例，次全切除3例，无1例手术死亡。仅有1例64岁老年病人术后并发高血压脑出血，于术后3个月死于8市部感染。其他多数病人术后仅出现较为短暂的多尿和低钠血症，经应用脑垂体后叶素和(或)长效尿崩停以及浓氯化钠溶液后效果良好，术后恢复良好。结论 采用经翼点皮切口眶上小骨窗入路显微外科技术切除鞍区大型肿瘤，均可做到显微镜下全切除或次全切除，且对脑组织损伤轻，肿瘤显露好，是较为理想的鞍区肿瘤手术入路。

Microsurgical excision of large sellar region tunors via supra-orbital small craniotomy through pterional incision

Objective To evaluate the clinical outcome of microsurgical excision of large sellar region tumors via supra-orbital small craniotomy through pterion al incision. Methods Twenty-one large sellar region tumors were all operated vi a supra-orbital small craniotomy through pterional incision. The scalp flap was incised through pterional approach, but with only small supra-orbital craniotom y. The bone hole is in elliptical size, which the maximal diameter only 3.5 to 4 .0 cm, and near to anterior fossa of the skull base. The tumors were excised us ing microsurgical techniques. Results The sellar region tumors were totally ex cised in 18, and sub-totally excised in 3. No patients died in peri-operative st age. Only one 64-year-old patient suffered from hypertensive intracerebral hemor rhage after surgery, and died off 3 month later because of pulmonary infection. Most of patients presented transient diabetes insipidus and hyponatremia after surgery. However, they all recovered very well after treated with posterior pitu itary injection or tannin vasopressin oleosus, and concentrated natrium chloride solution. All patients recovered well after surgery. Conclusion The large sel lar region tumors may be totally or sub-totally excised with microsurgical techn iques via supra-orbital small craniotomy through pterional incision. Such approa ch provides a better tumor exposure, lighter brain damage. So it is a rational surgical approach to the seller region tumors.