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目的:探讨颅眶区手术临床应用解剖,提高颅眶区肿瘤的治疗效果。方法:回顾总结采用前外侧硬脑膜外入路治疗的18例颅眶沟通瘤患者的临床资料。手术采用眶额或眶额翼点入路,眶板切除至眶上裂,咬除蝶骨嵴,打开眶上裂,切开颞极硬脑膜索带,结合圆孔处分离硬脑膜夹层,显露海绵窦前上外侧壁,于外直肌和上直肌起点之间切开Zinn腱环,依肿瘤大小、生长方向依次向前切开眶骨膜壁,显露肿瘤。结果:18例颅眶区肿瘤中,全切除14例,次全切除4例,全切除率为77.8%。眼球突出恢复正常或好转8例(8/10),眼球疼痛全部得到缓解。结论:颅眶沟通瘤采用前外侧硬脑膜外入路,肿瘤显露范围充分,可同时处理眶内肿瘤和颅内肿瘤,眶上裂的显微解剖有利于在处理切开总腱环时保护颅神经。
Objective: To investigate the clinical application of cranial orbital surgery anatomy and improve the treatment of cranial orbital tumors. Methods: The clinical data of 18 patients with cranio-orbital tumor who underwent anterolateral dural approach were retrospectively reviewed. Surgery using orbital quotas or orbital frontal point approach, orbital plate resection to the supraorbital fissure, bite sphenoid crest, open the superior orbital fissure, cut the temporal dural cord, combined with the round hole at the separation of the dural dissection, revealed The anterior superior lateral wall of the cavernous sinus was dissected between the lateral rectus and the upper rectus abdominis. The Zinn tendon was incised and the periorbital periosteum was incised anteriorly in order of tumor size and growth direction to reveal the tumor. Results: In 18 cases of cranio-orbital tumors, 14 cases were totally excised and 4 cases were subtotally resected. The total resection rate was 77.8%. Eight cases (8/10) of normal or improved eyeball protrusion, eye pain were all alleviated. CONCLUSIONS: Anterior or posterior lateral epidural approach is used for cranio-orbital communicating tumor. The tumor has a wide range of exposure. It can treat both orbital tumors and intracranial tumors simultaneously. The microsurgical anatomy of the superior orbital fissure facilitates the protection of the skull nerve.