【摘要】 目的探讨采用扩大经蝶窦入路切除蝶斜区肿瘤的方法。方法1999～2005年采用扩大经蝶入路切除蝶斜区肿瘤25例,肿瘤直径1.9～4.2cm;采用标准经鼻中隔蝶窦入路,先行切除经蝶入路视野内的肿瘤,而后调整Hardy扩张器方向指向斜坡方向,进行手术入路的扩大。根据术前影像学资料、术中"C"型臂监测、神经导航、神经内镜以及术者的经验决定斜坡骨质磨除或咬除的范围,直至显露正常骨质和硬脑膜。结果全切21例(84%),次全切除3例(12%),部分切除1例(4%)。结论采用扩大经蝶窦入路切除蝶斜区肿瘤,肿瘤显露满意,肿瘤全切除率高,无明显手术并发症。神经导航及内镜的辅助使得扩大经蝶入路更为安全、有效。更多还原

【Abstract】 Objective To investigate the microsurgical treatment for tumors of spheno-clival region via extended transsphenoidal approach. Methods Clinical data of 25 patients suffering from spheno-clival tumours treated by extended transsphenoidal approach was analyzed retrospectively. Standard transseptal transsphenoidal approach was adopted to expose the sellar floor and dura mater, and the tumors were removed. Then, the projection of Hardy’s speculum was modified to the clivus with the guidance of a fluoroscopic C-arm image. Under the assistance of frameless stereotactic guidance and endoscope, we used a high-speed drill to remove the clival bone for the exposure of the tumor. The resection should be stopped, once normal bone and dura mater appeared. Results Total removal of tumors was achieved in 21 cases (84%), and subtotal removal in 3 cases (12%), partial removal in 1 case (4%). Conclusion The extended transsphenoidal approach can provide the excellent exposure to the entire sphenoid sinus, sella turcia, and the upper clivus for resection of posterolateral or inferior extension of larger tumors involving the spheno-clival region. It has the advantages of low incidence of surgical complication and high total removal rate. Neuronavigation and endoscope may be helpful for this approach.更多还原