经海绵窦手术治疗海绵窦病变疗效观察(附58例报告)

目的：探讨海绵窦(C)病变的手术疗效、方法及影响肿瘤切除的因素。方法：58例CS病变患者施行经颅手术治疗，其中CS内动静脉瘘(AVF)11例，CS内异物(铅弹)2例，CS肿瘤45例。手术经额颞翼点开颅36例，额颞眶-颧弓开颅14例，幕上幕下联合经岩骨开颅8例；手术入路采用经CS上壁上方入路及经CS外侧壁侧方入路。行肿瘤全切28例，部分及次全切17例；对AVF者用止血海绵填塞CS静脉间隙；对CS内铅弹经Parkinson三角取出。结果：肿瘤全切率为63．2％，次全切及部分切除率为36．8％；9例CS内AVF患者的漏口完全消失，2例漏口部分消失者叉行血管内栓塞治疗；2例C内异物者均取出铅弹。1例脑膜瘤患者术后1周死于脑栓塞，出现动眼及外展神经功能障碍各6例。结论：CS病变手术疗效满意，并发症少。对术后影像学证实有残余肿瘤者，应行放疗或放射外科治疗。影响CS内肿瘤切除的因素主要为肿瘤性质、二次手术或放疗。

Effect of microsurgery by transcavernous approach on intracavernous lesions(58 cases reported)

Objective To explore the operative methods,operative effect and factors influencing the resectability of intracavernous lesions Methods 58 patients with intracavernous lesions were transcranially operated on microsurgery,of whom 11 with cavernous sinus(CS) dural arteriovenous fistulae(AVF), 2 with CS foreign body (plumbeous bullet), 45 with CS tumors The operations were carried out by frontotemporal craniotomy in 36 cases, by frontotemporal orbitozygomatic craniotomy in 14 cases, by combined supra infra tentorial transpetrousal craniotomy in 8 cases The approachs into the CS included the superior approach through its superior wall, the ateral (intra and extra) approach through its lateral wall In dural AVF the venous space of the CS was filled with hemostatic sponge The bullet was removed through the Parkinson triangle Results In tumor cases,28(63 2%)were resected totally, 17(36 8%) were resected subtotally or partially The fistulae were disappeared totally in 9 cases, the other 2 cases only partially disappeared and successive endovascular therapy was introduced Only 1 patient was dead because of the occlusion of the middle cerebral artery in the second postoperative week Deficit of the 3rd and/or 6th nerves appeared with their normal preoperative function in 12 cases Conclusion Overall, the operative effect of CS lesions is good with acceptable complications For the remnant tumors confirmed by the postoperative images,the conventional radiotherapy or radiosurgery are recommended The factors affecting the tumor resectability of the CS are the nature of the tumor, the second operation or preoperative radiotherapy and the involving range of the tumor,etc