经额外侧锁孔入路切除鞍区颅咽管瘤

目的探讨经额外侧锁孔入路切除鞍区颅咽管瘤的应用价值。方法对我院17例鞍上直径在2.5-4.8cm的颅咽管瘤患者采用额外侧锁孔入路发迹内做6.5cm左右皮切口,铣出面积约（3×2.5）cm^2的椭圆形小骨瓣,术中根据肿瘤位置利用不同解剖间隙切除肿瘤。结果术中15例病人肿瘤全部切除,2例次全切除。术后7例病人出现不同程度的尿崩症及电解质紊乱,经药物治疗后好转,9例病人视力改善。结论与传统翼点入路及眶上锁孔入路相比,额外侧锁孔入路切口小、创伤小,能提供足够的鞍上区手术空间,显露鞍区病变及其邻近结构充分,且减少了脑牵拉和手术创伤,有利于颅咽管瘤的全切除,是一种安全有效的处理鞍上颅咽管瘤的手术入路途径。

Trans-frontal lateral keyhole approach for excision of craniopharyngioma in the sella region

Objective To discuss the usefulness of trans-frontal lateral keyhole approach for excision of craniopharyngioma in the sella region.Methods 17 patients with tumors of suprasellar region were excised by trans-frontal lateral keyhole approach,the diameter of tumors varied from 2.5cm to 4.8cm（8 with partial cystic,2 with calcification,8 total solid）,Skin incision was made within the borderline of frontal hair,the area of oval-shape bone is approximately 3×2.5cm^2,tumors were excised according the position of tumor.Results 15 cases received total resection and 2 subtotal resection;7 cases had different degree of diabetes insipidus and electrolyte disturbance,which was improved by the drug treatment;the visual acuity of 9 cases was improved.Conclusion Compared frontal lateral keyhole approach with traditional pterion approach and supraorbital keyhole approach,the former has the characteristics of microinvasive,shorter operative time,quick recovery,and provides the fully exposed operative field,is an option of excise the craniopharyngioma of suprasellar.