Orbital roof craniotomy via an eyebrow incision: A simplified anterior skull base approach
Orbital roof craniotomy via an eyebrow incision: A simplified anterior skull base approach
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DOI：
10.1055/s-2008-1053424
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发表时间：
1997-09-01
影响因子：
--
通讯作者：
Jho, HD
中科院分区：
文献类型：
--
作者：
Jho, HD
利用脑保护性颅底手术和极简主义的概念结合，将额下和鞍旁区域肿瘤的传统额部开颅手术修改为眶顶开颅手术。通过 4 至 5 厘米 (cm) 长的眉毛切口，进行眶顶开颅手术（尺寸为 2 厘米 x 3 厘米），包括眶上弓，制成单片骨瓣。通过额外去除眼眶顶的骨头，将眼眶顶打开至眶上裂和视神经管。这将暴露眼球和眶额硬脑膜。当在硬脑膜的眼眶部分切开硬脑膜时，通过平头缝合线将眼眶内容物缩回。利用眼眶空间而不是颅内空间去除肿瘤。脑牵开器不是必需的，也不用于执行肿瘤切除术。该技术已用于三名颅咽管瘤患者、七名脑膜瘤患者和一名额下畸胎瘤患者。三名颅咽管瘤患者和五名额下或鞍旁脑膜瘤患者实现了大体全切除。两名复发性脑膜瘤患者和一名额下畸胎瘤患者实现了肿瘤次全切除。通过这种暴露，外科医生的手术空间足以实现手术目标。直接眉毛切口通过消除冠状切口所采用的头皮瓣，在颅底提供了宽度超过 1 厘米的额外重要工作空间。现结合11例病例报告介绍其手术方法。
Utilizing the conceptual combination of brain protective skull base surgery and minimalism, a conventional frontal craniotomy for tumors in the subfrontal and parasellar regions is modified to an orbital roof craniotomy. Through a 4 to 5 centimeter (cm) long eyebrow incision an orbital roof craniotomy (measuring 2 cm by 3 cm), including the supraorbital arch, is made as a single piece bone flap. The orbital roof is opened up to the supraorbital fissure and to the optic canal by additional removal of the bone in the orbital roof. This will expose the globe and the orbitofrontal dura mater. When the dural incision is made at the orbital portion of the dura mater, the orbital contents are retracted by tack-up sutures. The tumor is removed utilizing the orbital space rather than the intracranial space. Brain retractors are not necessary and are not used to execute the tumor resection. This technique has been used in three patients with craniopharyngiomas, seven patients with meningiomas, and one patient with a subfrontal teratoma. Gross total resection was achieved in three patients with craniopharyngiomas and in five patients with subfrontal or parasellar meningiomas. Subtotal resection of the tumor was achieved in two patients with recurrent meningiomas and in the patient with a subfrontal teratoma. The surgeon's operating space through this exposure was sufficiently ample to achieve the goals of the operation. The direct eyebrow incision provides an additional vital working space with a width of more than 1 cm at the skull base by eliminating the scalp flap which a coronal incision employs. The surgical technique is described with a report of 11 cases.