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目的初步总结经眶颧额颞下入路显微切除中颅底肿瘤的疗效和经验。方法回顾性分析近年来采用眶颧额颞下入路显微手术治疗的13例颅底肿瘤的分类、临床表现、影像学特征、手术技巧、切除程度和治疗结果。结果主要向中颅底生长的蝶骨嵴内1/3脑膜瘤3例,鞍旁-中颅窝底脑膜瘤4例,颅眶沟通脑膜瘤1例,下丘脑胶质瘤2例,主位于中颅窝底的脊索瘤2例,向鞍旁生长的巨大垂体瘤1例。2例肿瘤包裹同侧颈内动脉和大脑中动脉。术中切除颧弓4例。肿瘤全部全切,无术后死亡,术后尿崩2例,脑脊液漏并颅内感染1例,肺部感染1例。随访10例,死亡2例;术后8个月肿瘤复发1例。结论眶颧额颞下入路有肿瘤暴露充分、全切率高、并发症少等优点,适合于切除中颅底或主要向中颅底生长的相邻部位肿瘤。术中是否切除颧弓根据肿瘤的大小和生长方向而定。
Objective To summarize the curative effect and experience of microsurgical removal of mid-skull base tumors through frontotemporal zymopoietic infratemporal approach. Methods The classification, clinical manifestations, imaging features, surgical skills, resection degree and treatment outcome of 13 cases of skull base tumors treated by orbital zygomas under frontotemporal approach were retrospectively analyzed. The results mainly to the mid-skull base growth of sphenoid ridge 1/3 meningioma in 3 cases, parasellar - middle cranial fossa meningioma in 4 cases, cranio-orbital meningiomas in 1 case, hypothalamic glioma in 2 cases, the main 2 cases of chordoma at the base of cranial fossa and 1 case of giant pituitary tumor growing to the sella. Two tumors encircled ipsilateral internal carotid artery and middle cerebral artery. Intraoperative resection of the zygomatic arch in 4 cases. All the tumors were completely excised and no postoperative death was found. Two cases of postoperative diabetes insipidus, one case of cerebrospinal fluid leakage and intracranial infection, and one case of lung infection. Follow-up in 10 cases, 2 patients died; 8 months after tumor recurrence in 1 case. Conclusion Frontotemporal frontotemporal approach has the advantages of adequate tumor exposure, high total resection rate and few complications. It is suitable for the resection of the tumor in the adjacent skull base or in the adjacent parts of the skull base. Whether the surgery to remove the zygomatic arch tumor size and growth direction may be.