| Objective: The standard pterional approach has been a gold standard to approach lesions in the sellar and suprasellar region, Circle of Willis, Sylvian fissure and even the superior part of the clivus and basilar artery. Lateral supraorbital approach is established by J. Hernesniemi which is simpler,less invasve and faster than the standard pterional approach.The aim of this study is to assess the reliability and safety of the lateral supraorbital(LSO) approach to remove sellar tumors as the standard pterional approach.Methods: Between January 2011 and December 2012, 153 patients’ s clinical data was anlaysised with neoplastic lesions in sellar region underwent craniotomy. 23 cases were excluded by coronary and subfrontal approach. 130 patients were divided into two groups: the lateral supraorbital approach in 44 cases, pterional approach in 86 cases. The clinical presentations, neuroradiological findings, microsurgical techniques, and outcome at discharge of these patients were analyzed. Data were analyzed using t, χ2, rank sum test.Results: Lateral supraorbital approach group of 44 patients operation incision length was 9.5 ± 1.7cm,the average operation time was 152±41min, and days of hospitalization average 15.1 ±3.3. After 3 months follow-up,40 patients outcomes were good(90.9%), mild disability in 2 patients(4.5%), severe disability in 1 patients(2.3%),and 1 patient was died(2.3%). Nobody was found the temporal muscle atrophys after operation. Pterional approach group incision length was 16.7± 3.3cm, the average operation time was185 ±37min, and days of hospitalization average 20.8 ±9.3. After 3 months follow-up, 76 patients made good recovery(88.4%), 5 patients mild disability(5.8%), 1was severe disability(1.2%), plant survival in 1(1.2%), and 3 patients died(3.4%). 3 patients were found atrophy of temporal muscle after operation 3 months. Two groups in the postoperative visual recovery and the postoperative complication rate is no statistical difference. The operation time,incision length, operation hospitalization days, before and after operation of health status score difference exists significant difference. In 130 patients, 52 cases of pituitary tumor(40%), 35 cases of tuberculum sellae meningiomas(26.9%), 20 cases of craniopharyngioma(15.3%), 4 cases of cavernous hemangioma(3%), 4 cases of neurilemmoma(3%), 6 cases of Rathke’s cyst(4.6%), 1 patients with parasellar cyst(0.8%), 1 cases of teratoma(0.8%), 1 cases of metastatic tumors(0.8%), 1 cases of granular cell tumor(0.8%), 1cases of solitary fibrous tumor(0.8%), 1 cases of granular cell tumor(0.8%), 1cases of melanoma(0.8%), 1 cases of germ cell tumor(0.8%), 1 cases of dermoid cyst(0.8%).Conclusion: Sellar tumors can be removed via the LSO approach with relatively low morbidity and mortality. LSO is a relatively micro-invasive neurosurgery. The craniotomy is very fast,and there is no risk to injury the upper branch of the facial nerve. The smaller bone flap can be decreased the risk of CSF leak.Surgical results are similar to those obtained with more extensive, complex, and time-consuming approaches,such as pterional approach,supraorbiatal keyhole craniotomy.The LSO approach offers adequatie visualiztion and safe surgical manipulation within anatomic stuctures.It is a simple and as minmally invasive as possible for sellar tumor treatment. |
