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目的探讨采用微创技术处理颅眶肿瘤(COTs)的疗效。方法对56例颅眶肿瘤进行临床与影像学诊断,采用立体定向或神经导航技术,应用微创方法及不同手术入路切除肿瘤。全组病例中,肿瘤位于颅前凹49例,颅中凹7例,均累及眶腔的眶上嵴、眶顶或侧壁。其中38例(67.9%)有头痛、头晕等颅内压增高表现,53例(94.6%)出现视器症状。32例行数字减影血管造影(DSA)及术前颈外供瘤血管栓塞术。结果44例肿瘤(78.6%)获手术全切除,12例(21.4%)为次全切除。术后病人恢复良好,无死亡。对47例经信访或门诊随访6个月至9年(平均3.6年),38例(80.9%)恢复满意,余9例(19.1%)有不同程度后遗症。结论COTs多以视器改变为主要临床表现。选取不同的手术入路,在立体定向和神经导航辅助下,以微创技术处理本病,可明显地改善其预后。
Objective To investigate the curative effect of minimally invasive treatment of cranial orbital tumors (COTs). Methods The clinical and imaging diagnosis of 56 cases of cranio-orbital tumors were performed. Stereotactic or neuro-navigation techniques were used to remove the tumor using minimally invasive methods and different surgical approaches. In all cases, the tumors were located in the anterior cranial fossa in 49 cases and in the cranial fossa in 7 cases, all involving the supraorbital crest of the orbital cavity, the orbital roof or the lateral wall. Among them, 38 cases (67.9%) had headache, increased dizziness and other intracranial pressure, and 53 cases (94.6%) had visual symptoms. 32 cases of digital subtraction angiography (DSA) and preoperative external carotid artery embolization. Results 44 cases of tumors (78.6%) were surgically removed, 12 cases (21.4%) were subtotal resection. After the patient recovered well, no death. Forty-seven cases were followed up for 6 months to 9 years (average 3.6 years) through letters or outpatients, 38 cases (80.9%) recovered satisfactorily, and 9 cases (19.1%) had different degrees of sequelae. Conclusions Most of the changes of visual field are the main clinical manifestations of COTs. Select different surgical approach, with the aid of stereotactic and neuronavigation, minimally invasive treatment of the disease, can significantly improve its prognosis.