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目的探索改良手术入路和显微外科手术技巧,以提高颅底中线和旁中线部肿瘤的手术疗效。方法回顾性分析1991年1月-2001年12月施行手术治疗的168例颅底中线和旁中线部肿瘤患者的临床资料,其中肿瘤位于前颅底者64例、中颅底23例以及后颅底81例;中型(2～4cm)91例、大型(>4cm)77例。采用扩大前颅底入路、单侧额下入路、额下眶上匙孔入路、翼点入路、眶颧入路、眶颧颞极入路、岩骨联合入路、远外侧枕下入路及口-咽入路等9种不同手术入路方法施行手术。结果168例颅底部肿瘤患者,138例(82.1%)全切除,其中脑膜瘤全切除率为88.8%(79/89)、神经鞘瘤83.3%(35/42)、脊索瘤31.3%(5/16)、斜坡胆脂瘤93.3%(14/15)以及其他肿瘤83.3%(5/6)。手术后恢复良好者153例(91.1%),中度致残包括手术后失明或持久性精神症状者11例,重残3例,死亡1例(0.6%)。手术后新产生脑神经功能障碍25例(14.9%),与入路有关的并发症4例(2.4%)。结论合适的颅底手术入路、精良的手术技巧和正确的手术策略可以改善手术显露,扩大手术适应证,提高肿瘤全切除率,降低手术死亡率,减少手术并发症,提高患者的生存质量。
Objective To explore the improved surgical approach and microsurgical techniques to improve the surgical outcome of the skull base midline and midline tumors. Methods A retrospective analysis was performed on the clinical data of 168 patients with cranial midline and midline tumors treated surgically from January 1991 to December 2001. Among them, 64 were located in the anterior skull base, 23 in the middle skull base, The bottom 81 cases; medium (2 ~ 4cm) 91 cases, large (> 4cm) 77 cases. With the expansion of the anterior skull base approach, unilateral inferior frontal approach, frontal orbital keyhole approach, pterional approach, orbital zygomatic approach, orbital zygomatic pole approach, petrous bone approach, far lateral pillow Under the approach and mouth - pharyngeal approach 9 kinds of different surgical approach to surgery. Results Of the 168 patients with skull base tumors, 138 (82.1%) were resected. The total resection rate was 88.8% (79/89) in meningioma, 83.3% (35/42) in schwannoma, and 31.3% in chordoma 16), 93.3% (14/15) of grade cholesteatoma and 83.3% (5/6) of other tumors. 153 cases (91.1%) recovered well after operation, moderate disability included 11 cases of blind or persistent psychiatric symptoms after operation, 3 cases of severe disability and 1 case of death (0.6%). 25 cases (14.9%) had new neurological dysfunction after operation, and 4 cases (2.4%) had complications related to the approach. Conclusion Appropriate cranial skull approach, excellent surgical techniques and correct surgical strategies can improve the surgical exposure, expand the indications for surgery, improve the total resection rate, reduce the operative mortality, reduce surgical complications and improve the quality of life of patients.