颅底中线和旁中线部肿瘤的显微外科治疗

目的探索改良手术入路和显微外科手术技巧,以提高颅底中线和旁中线部肿瘤的手术疗效。方法回顾性分析1991年1月-2001年12月施行手术治疗的168例颅底中线和旁中线部肿瘤患者的临床资料,其中肿瘤位于前颅底者64例、中颅底23例以及后颅底81例;中型(2～4cm)91例、大型(>4cm)77例。采用扩大前颅底入路、单侧额下入路、额下眶上匙孔入路、翼点入路、眶颧入路、眶颧颞极入路、岩骨联合入路、远外侧枕下入路及口-咽入路等9种不同手术入路方法施行手术。结果168例颅底部肿瘤患者,138例(82.1%)全切除,其中脑膜瘤全切除率为88.8%(79/89)、神经鞘瘤83.3%(35/42)、脊索瘤31.3%(5/16)、斜坡胆脂瘤93.3%(14/15)以及其他肿瘤83.3%(5/6)。手术后恢复良好者153例(91.1%),中度致残包括手术后失明或持久性精神症状者11例,重残3例,死亡1例(0.6%)。手术后新产生脑神经功能障碍25例(14.9%),与入路有关的并发症4例(2.4%)。结论合适的颅底手术入路、精良的手术技巧和正确的手术策略可以改善手术显露,扩大手术适应证,提高肿瘤全切除率,降低手术死亡率,减少手术并发症,提高患者的生存质量。

Microsurgery in midline and paramidline basicranial tumors

Objective To study the operation approaches and microsurgical tec hnique for improving the therapeutic effect in midline and paramidline basicrani al tumors. Methods The clinical data of 168 patients with midline and paramidli ne basicranial tumors operated during Jan 1991 to Dec 2001 were retrospectively analyzed. Of these patients their tumors were locating at anterior base of skul l 64 cases, middle base of skull 23 cases and posterior base of skull 81 cases, including middle size (2-4 cm, n = 91) and large size (> 4 cm, n = 77). The pat ients were operated by 9 different approaches including expanded transfrontal ba sal, unilateral subfrontal, subfrontal supraorbital keyhole, pterional, orbitozy gomatic, orbitozygomatic temporopolar, transpetrosal and tentorial, extreme l ateral suboccipital, and transoral transpharyngeal approaches. Results Of the 1 68 patients with basicranial tumors, total removal were performed in 138 patient s (82.1%), among them the total resection rate was 88.8% (79/89) for meningioma, 83.3% (35/42) for schwanoma, 31.5% (5/16) for chordoma, 93.3% (14/15) for chole steatoma clivus and 83.3% (5/6) for the rest tumors. The postoperative good rec overy resulted in 153 patients (91.1%), moderate disablement 11 cases including blindness or prolonged mental disturbance 11 cases, severe disablement 3 cases and 1 death (0.6%). The novel established postoperative disturbance of cranial nerve function occurred in 25 patients (14.9%), operative complications associat ed with approaches were found in 4 patients (2.4%). Conclusion The appropriate basicranial surgical approaches, superior surgical technique and correct operati on guidline would improve the operation exposure, expand surgical indications, i ncrease the total removal rate and decrease surgical complication and mortality, thus the patients' quality of life will be improved.