论文部分内容阅读
目的探讨颅眶沟通瘤肿瘤的显微手术治疗的效果。方法35列患者根据肿瘤主体位置、大小和性质不同分别采用眶翼点入路(5例)、眶颧额颞(12例)入路和额眶入路(18例)进行显微切除手术。肿瘤切除后对前颅底骨质的缺损,分别采用游离骨膜加生物胶、带蒂额帽状腱膜瓣、带蒂颞肌筋膜瓣以及汰板加带蒂额帽状腱膜瓣等方法进行颅底缺损的修复。结果手术全切除28例,次全切除7例。手术后无脑脊液漏、搏动性突眼及颅内感染等严重并发症发生,无手术死亡。35例患者30例得到随访,随访时间8个月～10年。其中25例眼球突出患者22例术后恢复正常,3例明显减轻;26例视力视野损害患者22例术后恢复正常或明显好转,4例无明显变化;22例眼球运动障碍者术后18例灰复正常或明显改善,2例无变化,2例加重。结论肿瘤主体位置、大小和性质是决定选择不同手术入路的关键。术后根据前颅底骨质缺损的位置和范围不同,分别选择不同材料的修补方法能避免术后脑脊液漏等严重并发症的发生。
Objective To investigate the effect of microsurgical treatment of cranio-orbital tumor. Methods 35 patients underwent orbital pterygoid approach (5 cases), frontotemporal frontotemporal (12 cases) approach and frontal orbital approach (18 cases) underwent microsurgical resection according to the tumor location, size and nature. Tumor resection of the anterior skull bone defects, respectively, using free periosteum plus plastic, pedicle cap tentorial flap pedicled temporal muscle fascia flap and the plate plus pedicle flap aponeurotic flap and other methods The skull base defect repair. Results The total resection in 28 cases, subtotal resection in 7 cases. No postoperative cerebrospinal fluid leakage, pulsatile exophthalmos and intracranial infection and other serious complications, no surgical death. Thirty patients were followed up from 8 months to 10 years. Among them, 22 cases of 25 patients with prominent ophthalmopathy returned to normal postoperatively and 3 cases were relieved significantly. Twenty-two of 26 patients with visual field damage returned to normal or significantly improved after operation, and no significant change was found in 4 cases. Twenty-two cases of ocular movement disorders Gray complex normal or significantly improved, 2 cases no change, 2 cases worsened. Conclusion The location, size and nature of the main tumor are the key factors that determine the choice of different surgical approaches. According to the location and scope of the anterior skull base bone defect after surgery, different materials were selected to prevent serious complications such as cerebrospinal fluid leakage.