眶颧入路切除蝶眶脑膜瘤的显微外科治疗

目的探讨经眶颧入路治疗蝶眶脑膜瘤的手术效果和操作技巧，以提高全切率，降低并发症。方法回顾性分析2003年1月~2016年9月收治的21例蝶眶脑膜瘤的临床资料，包括患者发病年龄、性别、症状、影像学、手术方法、术后并发症和肿瘤复发率等。结果蝶眶脑膜瘤患者眼球突出和局部疼痛是主要的发病症状，少数可伴有视力轻度下降。肿瘤长径3~7 cm，平均4.5 cm。18例采用适当剪裁的眶颧（orbito zygomatic approach,OZ）入路开颅，3例翼点开颅保留眶缘、仅磨除肿瘤周围骨质（其中1例术后52个月因肿瘤复发再次手术）。21例患者其中切除14例（66.7%），近全切除6例（28.6%），部分切除1例（4.8%）。术后随访3个月以上，术后患者出现眼睑下垂、瞳孔扩大3例（14.3%），术后3个月复查时症状消失；1例偏瘫，后肌力恢复至IV+级。结论采用“适当剪裁”的眶颧入路，蝶眶处的脑膜瘤可良好显露；硬膜外预先处理肿瘤基底，血供可大大减少肿瘤出血；结合显微外科技术，可获满意的肿瘤切除效果和生存质量。

Microsurgical treatment of spheno orbital meningioma via orbitozygomatic approach

ObjectiveTo improve the total removal rate and reduce complications via investigating the therapeutic effect and surgical skill for microsurgical resection of spheno orbital meningioma via orbitozygomatic approach (OZA).MethodsClinical data of 21 patients suffering from spheno orbital meningioma surgically treated in our department from Jan. 2013 to Sep. 2016 were analyzed retrospectively. The analyzed data included patients'' age, gender, clinical symptoms, imaging features, surgical approaches, complications, and recurrence rates.ResultsThe major symptoms of spheno orbital meningioma were exophthalmos and local pain, although slight decreased vision in some cases. The diameter of the tumors ranged from 3 cm to 7 cm with an average of 4.5. The tumor was totally removed in 14 cases (66.7%), subtotally in 6(28.6%), and partially in one (4.8%). As for the surgical approach, OZA was adopted in 18 cases, and pterional approach combined with limited orbitotomy (only burring the bones around the tumor) in 3 cases including one with recurrence 52 months after the first operation via the modified pterional approach. All the patients were followed up for 3 to 87 months postoperatively. 3 patients had incomplete oculomotor nerve paralysis recovered 3 months later. One had hemiplegia with the muscle strength of the limbs recovered to grade IV+ latterly.ConclusionMeningioma located in the spheno orbital region can be well exposed via properly modified OZA. Epidural preliminary treatment of the tumor base can significantly reduce bleeding during tumor resection. With proper microsurgical techniques, spheno orbital meningioma can be satisfactorily removed via this appraoch.