Objective To investigate the peroperative treatment of cranio-orbital tumors and the method of the reconstruction of the skull base. Methods Between April 2008 and April 2011, 35 patients with cranio-orbital tumor were treated. There were 21 males and 14 females, aged 17-73 years (mean, 46.3 years). The first symptoms were orbital pain in 13 cases, hypopsia in 12 cases, exophthalmos or abnormal eye position in 5 cases, headache and dizziness in 2 cases, di plopia in 2cases, and pulsating eyeball in 1 case. Some of the patients needed resecting the zygomatic arch, supercil iary arch, and orbit roof. The autogenous bone, titanium net, frontal bone periosteum, biogel, and artificial meninges were used to reconstruct the skull base. Results Tumors were resected by one-stage operation, and the anterior skull bases were reconstructed. Postoperative MRI indicated that total removal of tumors was achieved in 30 cases, subtotal in 3 cases, and partial in 2 cases at 3 days. There was no operative death. Cerebrospinal rhinorrhea and infection occurred at 1 week in 1 and 2 cases respectively, and were cured after lumbar drainage and antibiotics. The patients were followed up 6 to 36 months (mean, 18 months). In patients having hypopsia, the visual function was improved in 9 cases at 1 month; in patients having orbital pain, pain rel ief was achieved at 2 weeks after operation; in patients having exophthalmos or abnormal eye position and pulsating eyeball, sympotoms disappeared after operation. In 27 patients with benign tumor, 24 were cured, without recurrence during follow-up; in 8 patients with mal ignant tumor, 6 had recurrence within 18 months and underwent second operation or radiotherapy, 2 relapsed cases died of cerebral hernia and respiratory circulating failure at 24 months after operation. No complication of enophthalmos, pulsating exophthalmos, or collapse of zygomatic region occurred. Conclusion Using the autogenous bone, titanium net, frontal bone periosteum, biogel, and artificial meninges to reconstruct the skull base has rel iable foundation, simple operation, and easy anatomical reconstruction, so it is an effective method after the removal of cranio-orbital tumors; better effectiveness would beobtained when combining with the peroperative nursing.
目的 探討經胼胝體-穹窿間入路切除第三腦室腫瘤術后，近期下丘腦反應的發生情況及相關因素，為防治第三腦室腫瘤術后下丘腦反應提供參考。 方法 回顧分析2003年1月－2008年12月經胼胝體-穹窿間入路切除的78例第三腦室腫瘤患者手術后近期（1個月內）下丘腦反應的發生情況，并將其按照腫瘤部位、病理性質、大小、血供、手術切除程度進行分類統計，用SPSS 13.0軟件logistic 回歸分析影響這些并發癥的因素。 結果 78例術后下丘腦反應37例，發生率47.4%；死亡5例，下丘腦反應病死率為13.5%（5/37）。其中電解質糖代謝紊亂33例（42.3%），尿崩癥27例（34.6%），激素水平低下16例（20.5%），高熱6例（7.7%）。好轉痊愈率：激素水平低下43.7%，其余均＞70%。第三腦室前部顱咽管瘤術后最容易發生下丘腦反應（P＜0.05）。 結論 經胼胝體-穹窿間入路切除第三腦室腫瘤術后近期存在程度不同的下丘腦反應，其發生與腫瘤部位、病理性質有密切關系。經積極治療，大部分下丘腦反應能在術后1個月內好轉甚至痊愈。