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目的:研究并探讨鞍区显微手术入路的临床应用情况,及其是否具有临床可行性、安全性及有效性。方法:以2009年1月至2011年12月期间本院收治的30例鞍区肿瘤患者为研究对象,分析其显微手术入路的方法及临床应用效果,探讨适合不同手术方式的手术入路及各自的特点和优势。结果:本组30例鞍区肿瘤患者,其中,垂体腺瘤12例,颅咽管瘤7例,鞍区脑膜瘤5例,蛛网膜囊肿3例,Rathke囊肿2例,上皮样囊肿1例;采用翼点入路19例,经眶上锁孔入路11例,采用神经内镜辅助手术者13例。术后采用MRI观察手术效果,19例眶上入路患者中,肿瘤全部切除15例,部分切除4例;11例经眶上锁孔入路者中,全部切除6例,部分切除3例。结论:翼点入路开颅的手术方法比较简单,操作也较方便,对于大多数患者均适用;经眶上锁孔入路联合颅底外科技术可减少对额叶的牵拉,对鞍区显露较大,增加手术视野,缩短了手术操作路径,适用于体积较大的鞍区肿瘤切除。
Objective: To study and discuss the clinical application of microsurgical approach in the saddle area, and whether it is clinically feasible, safe and effective. Methods: From January 2009 to December 2011 in our hospital, 30 cases of sellar tumor patients admitted to our hospital as the research object, analysis of its microsurgery approach and clinical application results to explore different surgical approaches to surgical approach And their own characteristics and advantages. Results: The group of 30 patients with sellar tumors, including 12 cases of pituitary adenoma, 7 cases of craniopharyngioma, 5 cases of sella meningioma, 3 cases of arachnoid cyst, 2 cases of Rathke cyst, 1 case of epithelioid cyst; Nineteen cases were treated by pterional approach, 11 cases were treated by supraorbital keyhole approach and 13 cases were assisted by endoscopic neurosurgery. After operation, the effect of surgery was observed by MRI. Among the 19 patients who underwent supraorbital approach, all the tumors were resected in 15 cases and partial resection in 4 cases. Of the 11 cases who underwent supraorbital keyhole approach, all were resected in 6 cases and partially resected in 3 cases. CONCLUSION: The pterional approach for craniotomy is relatively simple and easy to operate, which is suitable for most patients. The supraorbital keyhole approach combined with skull base surgery can reduce the frontal lobe stretch, Revealed larger, increase the surgical field of vision, shorten the surgical operation of the path for the larger resection of sellar tumors.