摘要目的 探讨眶上外侧(LSO)入路在嗅沟脑膜瘤切除手术中应用的安全性和有效性.方法 回顾性分析2013年1月至2016年12月浙江大学医学院附属第二医院神经外科采用LSO入路手术的20例嗅沟脑膜瘤患者的临床资料,根据影像学检查结果、神经系统症状改善情况及相关评分量表评估采用LSO入路切除嗅沟脑膜瘤的安全性和有效性.结果 20例患者中,Simpson Ⅰ级切除6例,SimpsonⅡ级切除12例,SimpsonⅣ级切除2例.平均手术时长为(204.8 ±77.4) min,平均出血量为(192.5±109.2) ml.术后出现发热4例,精神症状1例,意识障碍1例,癫痫1例,脑水肿1例,无一例出现脑脊液漏或切口感染.术前存在嗅觉功能损害的8例患者中,2例术后改善,6例无变化;术前存在视觉功能损害的4例患者中,2例术后改善,1例无变化,加重1例.随访3 ～ 40个月,平均(16.4±9.7)个月.获随访的19例患者中,术后效果满意16例,2例复发,1例病情危重,无死亡病例.结论 LSO入路在可安全全切除嗅沟脑膜瘤的同时具有手术时间短、创伤小、并发症少以及病死率低等优势,值得推广.

abstractsObjective To investigate the safety and efficacy of the application of lateral supraorbital (LSO) approach for microsurgical resection of olfactory groove meningiomas.Methods Between January 2013 and December 2016,20 patients with olfactory groove meningiomas underwent surgery through LSO approach at Department of Neurosurgery,the Second Affiliated Hospital of Zhejiang University School of Medicine.Their clinical data,surgical treatment and outcomes were analyzed retrospectively.Neuroradiological findings,improvement of symptoms and some relevant evaluation scales were used to assess the efficacy and safety of LSO for resection of olfactory groove meningiomas.Results Six patients had Simpson grade Ⅰ resection,12 had Simpson grade Ⅱ grade resection and 2 had Sign grade Ⅳ resection.The mean operation time was 204.8 ±77.4 min and the mean intraoperative blood loss was 192.5 ±109.2 ml.Four patients developed fever post operation,1 had psychiatric symptoms,1 had disturbance of consciousness,1 had cerebral edema,and 1 developed seizure.No incision infection or cerebrospinal fluid rhinorrhea occurred.Post surgery,2 out of 8 patients with preoperative im~nt of olfactory function obtained symptomatic improvement.Among the 4 patients with vision impairment,2 achieved improvement,1 remained the same and 1 reported aggravation.During the follow-up of 19 patients lasting 3-40 months with an average of 16.4 ±9.7 months,favorable outcomes were reported in 16 cases,severe disability in 1 and tumor recurrence in 2.There was no death.Conclusion Microsurgery through LSO approach demonstrates advantages in resection of olfactory groove meningiomas including shorter operative duration,less invasiveness,and low morbidity and mortality,which is thus worthy of recommendation.