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目的探讨鞍区及鞍周肿瘤经眉弓锁孔入路显微手术方法及临床疗效。方法回顾性分析25例经眉弓锁孔显微手术切除的鞍区及鞍周肿瘤的临床资料和手术方法,其中颅咽管瘤7例,垂体巨大腺瘤11例,鞍结节脑膜瘤4例,鞍膈脑膜瘤1例,蝶骨嵴脑膜瘤1例,鞍区及Ⅲ室巨大胶质瘤1例。部分病例术中采用神经内镜辅助观察。结果术后复查MRI显示,颅咽管瘤5例全切除,2例次全切除;垂体巨大腺瘤全切除10例,次全切除1例;脑膜瘤全切除5例,次全切除1例;巨大胶质瘤1例镜下全切除。无手术死亡、颅内出血、感染等并发症,术后尿崩6例,3日至1月后恢复正常,视力下降2例,并发脑血管痉挛而行去骨瓣减压术1例。近期随访疗效良好。结论眉弓锁孔入路适用于鞍区及鞍周肿瘤的手术切除。具有手术路径短、创伤性小、切除率满意、疗效佳等特点。内镜术中辅助观察可提高肿瘤全切率,减少神经血管结构的损伤。
Objective To study the microsurgical methods and clinical effects of transsexual keyhole approach in the sellar area and the sella of the perineum. Methods The clinical data and surgical methods of 25 cases of secundum and peritumoral tumors resected by eyebrow keyhole microsurgery were retrospectively analyzed. Among them, 7 cases were craniopharyngioma, 11 cases were pituitary adenoma, 4 cases were saddle nodular meningioma, 1 case of saddle diaphragm meningioma, 1 case of sphenoid ridge meningioma, 1 case of saddle zone and Ⅲ giant gioma. In some cases, neuroendoscopy assisted the observation. Results Postoperative MRI showed that 5 cases of craniopharyngioma were excised and 2 cases were subtotally resected. There were 10 cases of giant pituitary adenoma, 1 case of subtotal resection, 5 cases of meningiomas, 1 case of subtotal resection, One case of giant glioma undergone total resection. No operative death, intracranial hemorrhage, infection and other complications, postoperative diabetes insipidus in 6 cases, returned to normal after 3 days to January, decreased visual acuity in 2 cases, complicated by cerebral vasospasm and decompressive craniectomy in 1 case. Recent follow-up effect is good. Conclusions Eyebrow keyhole approach is suitable for the surgical resection of sellar region and sella. With a short surgical path, a small traumatic, resection rate satisfaction, good effect and so on. Auxiliary observation in endoscopic surgery can improve the rate of tumor resection and reduce the damage of neurovascular structures.