Clinical Studies Of Supraorbital Keyhole Approach For Excision Of The Sellae Region Lesion

Objectiv: To discuss the methods, efficacy and microsurgery technique with supraorbital keyhole approach through superciliary arch for treatment of the sellae region lesions.Method: A total of 24 cases of sellar tumors were treated with supraorbital keyhole approach surgical resection in The First Affiliated Hospital of Guangxi Medical University from March 2006 to March 2008, among them there were pituitary adenoma 16 cases, meningioma 5 cases, craniopharyngioma 3cases. The case selection criteria: tumor in order to saddle up and parasellar growth mainly in the saddle on the main (Some do not fit endonasal transsphenoidal approach for patients with pituitary tumor). The operations was performed with 5cm skin incision, the frontal muscle periosteous flap was dragged upwards and the orbicularis muscle periosteous flap was dragged downwards. Then the tempotal muscle was dragged laterally. The position of the keyhole was located behind the temporal line. By using a milling cutter, a bone window 2 cm×3 cm in size was made medially. The inner margin of the supraorbital skull was shaped to expand the visual field of microsurgery. The cerebral dura mate was opened curvily, with the base directing to the orbital margin. The frontal lobe was elevated gently and the cerebrospinal fluid was drained. The tumor was fully exposed and resected under microscope. By studying the supraorbital keyhole approach and comparing with the traditional approach.Result: Supraorbital keyhole approach was performed in 24 patients. Of the 16 cases with pituitary adenoma, total removal rate was 75% (12 cases), subtotal removal rate was 25% (4 cases). In 5 cases with meningioma, 3 cases of total removal, subtotal removal in 2 cases. Of the 3 cases with craniopharyngioma, 1 cases of total removal, subtotal removal in example 1 and another 1 partial removal. All patients had no complications such as infection and hemorrhage except 1 case who suffered transitory diabetes insipidus. We found that no significant difference of the curative effect between two approachs; but, the average length of stay at such date comparison, the key group approach has obvious advantages.Conclusion: The supraorbital keyhole approach through superciliary arch can obviously diminish the operation-trauma, reduce the length of stay in hospital, and has proven to provide sufficient operating space in the sellae region, thorough resection of tumor. It is a good choice for some kinds of patients with the tumors in the sellae regions and worth promoting.