翼点入路显微手术切除前中颅底病变

目的 介绍经翼点入路显微手术切除前中颅底病变的临床应用和经验。方法 选择分析一组不同病变部位的病例经翼点及其改良术式进行显微外科手术。结果 无手术死亡，其中，颅底脑膜瘤、三叉神经鞘瘤、海绵状血管瘤及胆脂瘤做到全切；颅咽管瘤3例大部切除，1例全切。镜下全切除率68％，3例出现术后一过性尿崩，处理后均1周内缓解，双侧嗅神经保留率80％，全部病例显露良好，经终板间隙处理病变2例。结论 掌握翼点入路各间隙及有关脑底动脉的显微解剖．不断提高该入路的操作水平．配合显微外科技术，可提高前中颅底肿瘤的全切除率，减少并发症。

Microsurgical removal via pterional approach of tumors in anterior and middle skull base

Objective To introduce our experience of application of the pterional approach in microsurgical removal of tumors in anterior and middle skull base. Methods 31 patients with different locations of lesions ranging from anterior to middle skull base were treated microsurgically via pterional and modified pterional approach. Results Complete removal was performed in 21 cases(68 %) which are meningioma, trigeminal neurinoma, cavernous hemangioma, cholesteatoma and one case of craniopharyngioma. The other three craniopharyngiomas underwent subtotal removal. No patients died of postoperative complications. Only 3 patients suffered from postoperative transient diabetes insipidus, which got better within one week after transaction. The bilateral olfactory nerves were preserved in 80 %. All lesions were well exposed under microscope. Conclusion It is key to master the interrelated microanatomic features of the pterional approach and microsurgical technique, for increasing the total removal rate and improving the prognosis.