改良翼点入路显微手术治疗鞍区肿瘤

目的探讨经改良翼点入路显微手术治疗鞍区肿瘤的方法。方法回顾性总结近4年来我院神经外科采用改良翼点入路显微手术治疗的326例鞍区肿瘤病例，其中，垂体腺瘤158例，颅咽管瘤89例，鞍区脑膜瘤79例。术前准备主要是进行糖激素的替代疗法和癫痫的预防。手术采用改良翼点入路，显微镜下解剖脑底诸池，经鞍区的5个手术间隙切除肿瘤。术后处理主要包括严密观察病人的意识、尿量和血清电解质，及时防治尿崩症、电解质紊乱等并发症，预防癫痫和糖皮质激素的替代疗法。结果采用改良翼点入路开颅，面神经额支的保留率达到92％，眶上神经的保留率达到96％，颞肌萎缩发生率为0％；全部肿瘤的全／次全切除率达到95％，垂体柄的保留率达到62％；术后并发症主要为尿崩症和电介质紊乱，发生率虽然高达61％，但是经过术后的严密观察和处理，97％的病人在术后1个月内得到恢复。结论改良翼点入路对面神经额支、眶上神经和颞肌的损伤机会减少。采用改良翼点入路，应用显微解剖技术，结合积极有效的防治并发症的措施，可以提高鞍区肿瘤的全切除率，减少术后并发症的发生，值得在临床中推广应用。

Treatment of Sellar Region Tumors by Microsurgery via Modified Transpterional Approach

Objective To investigate the methods of treatment of sellar region tumors by microsurgery via modified transpterional approach. Methods The clinical data of 326 patients with sellar region tumors were retrospectively analyzed. All patients(158 cases with pituitary adenomas, 89 cases with craniopharyngiomas and 79 cases with meningiomas)were treated by microsurgery via modified transpterional in our hospital inrecent 4 years. The most important part of pre-operative arrangement was giving glucocorticoid and anti-epilepsy drugs. Modified transpterional craniotomy was performed and the tumors were removed by microsurgical techniques via the 5 anatomy interspaces in sellar region after the subarachnoid cisterns were dissected carefully under surgical microscope. Consciousness, urine and serum electrolyte of the patients were observed strictly after surgery, and the complications such as diabetes insipidus, serum electrolyte disorder and epilepsy were treated in time. Result The rate of intact frontal branch of facial nerve was 92% and that of intact supraorbital nerve was 96%. Atrophy of temporal muscle occurred in none of the patients. Total and/or subtotal resection of tumors was achieved in 95% of the patients and the rate of intact pituitary stalk was 62%. The major post-operative complications included diabetes insipidus and serum electrolyte disorder. Although the incidence of complications was high to 61%, complete restore was achieved in 97% of the patients with the complications within 1 month. Conclusion There is a less incidence of damage to frontal branch of facial nerve, supraorbital nerve and temporal muscle with the modified transpterional approach. It can be achieved to increase the incidence of total resection of sellar region tumors and to decrease the incidence of post-operative complications by employing modified transpterional approach and the microsurgical techniques, combined with the active treatments of post-operative complications, therefore it deserves to be spread to use in clinical works.