Objective To investigate the skull base meningiomas communicate through the superior orbital fissure cranio-orbital approach of microsurgical Methods and the efficacy.Methods 80 cases with skull base meningiomas were randomly divided into the control group and observation group,40 cases in each group.The control group was given contact microsurgery,and the observation group received communication through the superior orbital fissure cranio-orbital approach of micro-surgery.The improvement of symptoms and postoperative complications were compared and analyzed.Results (1)The operative time,blood loss,blood transfusion,Simpson grade (Ⅰ,Ⅱ,Ⅲgrade),DKPS,postoperative hospital stay and mortality rate in the control group were (9.28 ± 0.97)h,(1 222.38 ± 89.07) mL,(1 099.35 ±56.72) mL,14/17/9,3.21 (0,6.44),(29.78 ±3.29)d and 7.50％ (3/40),which in the observation group were (7.02 ± 0.65) h,(877.34 ± 44.50) mL,(677.10 ± 32.28) mL,29/9/2,3.26 (-3.33,10),(20.00 ± 2.75) d and 5.00％ (2/40).The differences of operative time,blood loss,blood transfusion,Simpson level,postoperative hospital stay between the two groups were statistically significant(t =4.209,4.997,5.823,x2 =4.011,t =5.711,P =0.033,0.027,0.018,0.022,0.013),but the D KPS and mortality between the two groups had no significant differences (t =0.433,0.096,P =0.089,0.317).The monocular prominent,eye movement disorder and vision improvement rates in the control group were 66.67％,72.22％ and 75.68％,which were significantly lower than 92.31％,94.12％ and 97.14％ in the observation group (x2 =5.932,4.381,6.793,P =0.027,0.033,0.020).The postoperative eye movement disorder,on ptosis,eye abduction,subcutaneous fluid and intracranial infection rates in the control group were 10.00％,15.00％,30.00％,12.50％ and 7.50％,those in the observation group were 7.50％,5.00％,10.00％,10.00％ and 7.50％.The postoperative eye movement disorder,subcutaneous fluid and intracranial infection rates had no significant differences between the two groups(x2 =0.923,1.033,0.785,P =0.387,0.595,0.233).The incidence rates of postoperative ptosis,abduction eyeball had statistically significant differences between the two groups (x2 =6.299,7.889,P =0.018,0.009).Conclusion The skull base meningiomas communicate through the superior orbital fissure cranio-orbital approach of microsurgery has significant effect than the conventional contact microsurgery,which deserves to be promoted in clinical.%目的 探讨经眶上裂沟通颅眶入路的显微手术治疗颅底脑膜瘤的临床疗效.方法 将80例颅底脑膜瘤患者按照抽签方法随机均分为对照组与观察组,各为40例;对照组采用接触式显微手术,观察组采用经眶上裂沟通颅眶入路的显微手术,对两组手术效果、临床症状改善情况及术后并发症发生情况进行对比分析.结果 对照组手术时间、失血量、输血量、Simpson级别(Ⅰ、Ⅱ、Ⅲ级)、DKPS、术后住院天数及病死率分别为(9.28 ±0.97)h、(1 222.38±89.07) mL、(1 099.35±56.72) mL、14/17/9、3.21(0,6.44)、(29.78±3.29)d及7.50％(3/40),观察组分别为(7.02±0.65)h、(877.34±44.50) mL、(677.10 ±32.28)mL、29/9/2、3.26(-3.33,10)、(20.00±2.75)d及5.00％(2/40),两组在手术时间、失血量、输血量、Simpson级别、术后住院天数方面的差异均有统计学意义(t=4.209、4.997、5.823,x2=4.011,t=5.711,P=0.033、0.027、0.018、0.022、0.013),但两组DKPS与病死率差异均无统计学意义(x2 =0.433,t =0.096,P=0.089、0.317).对照组单眼突出、眼球活动障碍及视力改善率分别为66.67％、72.22％及75.68％,均显著高于观察组(分别为92.31％、94.12％及97.14％)(x2=5.932,4.381,6.793,P=0.027、0.033、0.020);对照组术后眼球活动障碍、上睑下垂、眼球外展受限、皮下积液及颅内感染率分别为10.00％、15.00％、30.00％、12.50％及7.50％,观察组分别为7.50％、5.00％、10.00％、10.00％及7.50％,两组术后眼球活动障碍、皮下积液及颅内感染发生率差异均无统计学意义(x2=0.923,1.033,0.785,P=0.387、0.595、0.233),两组术后上睑下垂、眼球外展受限发生率差异均有统计学意义(x2 =6.299,7.889,P=0.018、0.009).结论 颅底脑膜瘤经眶上裂沟通颅眶入路的显微手术效果显著,优于传统接触式显微手术,值得在临床上加以推广并应用.
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