| OBJECTIVE: the objective of this study is to explore the clinical application value and advantages of the two approaches for craniotomy treatment of tumors in the sella region through lateral supraorbital approach versus pterional approach.METHODS: the clinical data of 124 patients who diagnosed with tumors in the sella region was analyzed retrospectively,from January 2016 to January 2020 in the Department of Neurosurgery of the First Affiliated Hospital of Guangxi Medical University.36 cases were excluded from other approaches,combined with other diseases and other treatments such as gamma knife,and 98 cases met the inclusion criteria: 43 cases(male 16,female 27)were performed with the lateral supraorbital approach and the 45 cases(male 15,female 30)were performed with pterional approach.Statistical analysis was done on preoperative symptom,preoperative and postoperative pituitary function,preoperative and postoperative visual function,imaging data,duration of surgery,intraoperative blooding volume,length of postoperative hospitalization,degree of tumor resection,postoperative pathology,and complications,postoperative GOS scores,and postoperative 3 months KPS scores.RESULT:In the LSO group,30 patients(76.7%)achieved subtotal resection of tumor and above.14 patients(32.6%)got visual function improved and 26 patients(60.5%)kept stable,and 3 patients(7.0%)had visual function deteriorated postoperatively.The average operation time was 223.1 ± 58.6min,the average intraoperative blooding volume was 253.0 ± 179.2ml,and the average maximum diameter of bone window was 5.33±0.63 cm.The average postoperative hospitalization was 16.6 ± 13.7day.6 patients(14.0%)had intracranial infection,9 patients(20.9%)had temporary diabetes insipidus and 10 patients(23.3%)had pituitary dysfunction after operation.The average hospitalization expense was 53430.9±24896.5 RMB.The pathology was as follows: 21 cases of meningioma,11 cases of craniopharyngioma,5 cases of pituitary tumor,1 cases of cavernous hemangioma,2 cases of epidermoid cyst,,1 cases of metastatic encephaloma,1 case of arachnoid cyst and 1 case of ependymoma.In the PA group,42 patients(93.3%)achieved subtotal resection of tumor and above.13 patients(28.9%)got visual function improved and 25 patients(55.6%)kept stable,and 7 patients(15.6%)had visual function deteriorated postoperatively.The average operation time was 325.5±101.2 min,the average intraoperative blooding volume was 625.6±740.8 ml,and the average maximum diameter of bone window was 7.36±0.93 cm.The average postoperative hospitalization was 19.6±15.3 day.12 patients(26.7%)had intracranial infection,21 patients(46.7%)had temporary diabetes insipidus and 21 patients(46.7%)had pituitary dysfunction after operation.The average hospitalization expense was 68884.5±44323.5 RMB.The pathology was as follows: 24 cases of meningioma,8 cases of craniopharyngioma,6 cases of pituitary tumor,1 cases of cavernous hemangioma,2 cases of astrocytoma,1 cases of metastatic encephaloma,1 case of hemangiopericytoma,1 case of chordoma and 1 case of undetermined tumor(small round cell and spindle cell tumors).The comparison of the data between the two groups of patients showed no significant difference in visual function,length of postoperative hospitalization,postoperative GOS score,and KPS score at three months postoperatively(P<0.05).The LSO group were better than the PA group in the operation time,intraoperative bleeding,hospitalization expense,bone window size,hormone dysfunction,and postoperative complications.But the degree of tumor resection in the PA group was higher than that in the LSO group(P>0.05).CONCLUSION: Compared to the pterional approach,it is less invasive,easy to operate,less postoperative complications and have similar short-term prognosis in the craniotomy with lateral supraorbital approach.Because of the partial bony protuberance of the skull base,intrasellar and parasellar parts of some tumors have limited exposure through the lateral supraorbital approach,therefore,the exposure and resection of tumors through the pterional approach is superior.The surgeon should perform preoperative imaging evaluation to avoid its shortage.Both two approaches can easily provide the corresponding natural clearance for tumor resection,which is equivalent to the exposure of sella region.However,the pterional approach provides wider conical operation space from the side,better exposure of postsellar region,but greater damage,which is more likely to cause pituitary dysfunction.There is no significant difference between the two approaches in terms of visual function,but the exposure angle and operation space of pterion approach have theoretical advantages in the protection of optic nerve and optic chiasm.Only the anterior part of the temporal muscle be incised through the supraorbital lateral approach,which can reduce the atrophy of the temporal muscle,the injury probability of the branches of the facial nerve and the superficial temporal artery is small. |
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