颅眶沟通性视神经鞘脑膜瘤的显微手术治疗

目的 探讨经额眶入路显微手术切除颅眶沟通性视神经鞘脑膜瘤的临床效果。方法 回顾性分析2009年1月至2014年1月经额眶入路显微手术治疗26例颅眶沟通性视神经鞘脑膜瘤患者的临床资料。结果 肿瘤全切除25例，次全切除1例；肿瘤全切除率为96.2%。无手术死亡病例及颅内感染、脑脊液漏、搏动性突眼等并发症发生。术后新出现4例眼球运动障碍，3个月后1例完全恢复，3例不全麻痹。术后出现10例上睑下垂，3个月后7例病人不同程度恢复上睑抬举功能，3例无恢复。术后1月全切病例行视神经管周伽玛刀治疗，次全切病例行肿瘤残余部分伽玛刀治疗。术后随访3~36个月，平均10.3月，MRI检查示全切病例无肿瘤复发，未全切患者未见残余肿瘤增大。结论 经额眶入路切除颅眶沟通性视神经鞘脑膜瘤是较好的手术方式，全切率高，并发症少，结合术后辅助伽玛刀治疗效果满意。

Microsurgery through fronto-orbital approach for cranio-orbital optic nerve sheath meningiomas (report of 26 cases)

Objective To explore the clinical effect of microsurgery through fronto-orbital approach on cranio-orbital optic nerve sheath meningiomas. Method The clinical data of 26 patients with cranio-orbital optic nerve sheath meningiomas who underwent microsurgery through fronto-orbital approach in our department from January, 2009 and January, 2014 were analyzed retrospectively. Results Of 26 patients, 25 received total resection of the tumors and 1 subtotal. No patients died from the operation, and there were no postoperative complications such as intracranial infection, cerebrospinal fluid leakage and pulsatile exophthalmus in all the patients. The eye balls movement disorder occurred after the operation in 4 patients, of whom, 1 were perfectly recovered from the eye balls movement disorder and 3 partly 3 month after the operation. The ptosis of the eyelids occurred after the operation in 10 patients, of whom, 7 were partly recovered from the ptosis of the eyelids and 3 not 3 months after the operation. The tissues surrounding the optic canals were irradiated by γ-knife in 25 patients undergoing the total resection of the tumors and the timorous residue was irradiated by γ-knife in 1 patient undergoing the subtotal resection of the tumor after the operation. All the patients were followed up from 3 to 36 months (mean, 10.3 months). MRI showed that the tumors did not recur in 25 patients undergoing the total resection of the tumors and the volume of the residual tumor did not enlarge in 1 patient undergoing the subtotal resection of the tumor during the follow up. Conclusions Microsurgery through the fronto-orbital approach is a good method to treat the cranio-orbital optic nerve sheath meningiomas. The curative effect of the microsurgery through the fronto-orbital approach combined with postoperative γ-knife on the cranio-orbital optic nerve sheath meningiomas is satisfactory.