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目的:分析颅眶沟通肿瘤显微外科治疗的手术方法和治疗效果。方法:回顾分析自2001年至2011年在我科住院并接受手术治疗的6例巨大型颅眶沟通肿瘤的临床资料,所有病例最大径均大于4cm。结果:2例开颅术前先行肿瘤供血动脉栓塞。6例肿瘤全切除4例,次全切除2例,后者术后行伽玛刀治疗。无手术死亡及严重并发症。全切除的4例中有1例复发而行伽玛刀。次全切除的2例中有1例复发。5例术前视力下降患者视力均有不同程度好转。2例复视者1例好转。1例术后动眼神经损伤者未见好转。结论:(1)应根据肿瘤的起源、大小、沟通路径、累及范围、周边重要结构的受累程度、患者的手术耐受情况及术者的习惯等进行手术入路的优化选择。(2)手术的原则应在降低致残率,保全功能的基础上尽量多的切除肿瘤。条件允许时可行术中电生理监测减少并发症的发生,神经导航可提高手术全切率。(3)脑脊液漏是术后最常见的并发症。手术后颅底的重建对于避免脑脊液漏,提高手术成功率极为重要。(4)对于体积较大,考虑血供较为丰富的肿瘤,术前可行脑血管造影了解血供情况,可能情况下行供血动脉栓塞以减少术中出血。
Objective: To analyze the surgical methods and therapeutic effects of microsurgical treatment of cranio-orbital tumors. Methods: The clinical data of 6 giant orbital tumors communicating in our department from 2001 to 2011 were retrospectively analyzed. The maximum diameters of all cases were more than 4 cm. Results: Two patients underwent cranial artery embolization before craniotomy. 6 cases of total tumor resection in 4 cases, subtotal resection in 2 cases, the latter after gamma knife treatment. No operative deaths and serious complications. One of 4 cases underwent total resection and gamma knife. One of the 2 subtotal resections recurred. 5 cases of preoperative visual acuity decreased visual acuity improved in varying degrees. 2 cases of double vision in 1 case improved. One case of oculomotor nerve injury did not improve. Conclusion: (1) The optimal choice of surgical approach should be based on the origin, size of the tumor, the communication path, the scope of the involvement, the degree of involvement of the surrounding important structures, the patient’s tolerance to the operation and the habits of the surgeon. (2) the principle of surgery should reduce the morbidity, preservation function on the basis of as much as possible to remove the tumor. When conditions permit feasible intraoperative electrophysiological monitoring to reduce the incidence of complications, neuro-navigation can improve the surgical full-rate. (3) Cerebrospinal fluid leakage is the most common complication after surgery. Reconstruction of the skull base after surgery for the avoidance of cerebrospinal fluid leakage and improve the success rate of surgery is extremely important. (4) for larger, consider more abundant blood supply of tumor, preoperative cerebral angiography to understand the blood supply, arterial embolization may be the case to reduce intraoperative bleeding.