Abstract: Objective To compare the clinical effect between lateral supraorbital (LSO) approach and pterional approach for parachiasmal meningiomas.Methods A retrospective analysis of 90 patients with parachiasmal meningiomas who underwent microsurgery treatmentin our hospital,including 40 patients with LSO approach and 50 patients with pterional approach.Follow-up was completed at least 1 year postoperatively.The surgical outcomes,aesthetic outcomes associated with the approachand complications associated with the approach were analyzed retrospectively.Results There were no significant differences in preoperative brain edema,tumor characteristics,surgical resection degree,brain tissue traction injury,temporary surgical complications,postoperative visual outcome between the two groups (P>0.05).But the mean approach time,total operative time and hospital stay of LSO approach were shorter than those of pterional approach,and the blood loss during operation was also less than that of pterional approach (P<0.05).There was no temporalis muscle atrophy or visible scar outside the hairline in LSO approach,but the temporalis muscle atrophy or occurrence of visible scar outside the hairline of pterional approach were respectively 16.0% (8/50) and 86% (43/50),P<0.05.Therefore,the complete aesthetic satisfaction of LSO approach was higher than that of pterional approach (P<0.05).Conclusion LSO approach may provide a safe,rapid and less invasive exposure for parachiasmal meningiomas,and may be a reasonable alternative to the pterional approach.

Key words: Lateral supraorbital (LSO) approach, Pterional approach, Parachiasmal meningiomas, Microsurgery, Surgical outcomes, Aesthetic benefits

摘要： 目的 比较眶外侧(LSO)入路与翼点入路治疗视交叉旁脑膜瘤的临床疗效。方法 选取我院进行显微手术治疗的视交叉旁脑膜瘤患者90例,其中40例选择LSO入路,50例选择标准翼点入路,术后完成至少1年随访。对2组的手术结局、与入路相关的美学结果以及术后入路相关并发症进行回顾性分析。结果 2种入路组患者在术前脑水肿、肿瘤特征、手术切除程度、脑组织牵拉损伤程度、暂时性外科手术并发症、术后视觉结局等方面没有统计学差异(P>0.05)。但是LSO入路的平均手术入路时长、手术总时长、患者住院时长均短于翼点入路,且术中失血量也少于翼点入路(P<0.05)。LSO入路患者无颞肌萎缩或发际线外有明显疤痕,而翼点入路患者颞肌萎缩率和发际线外疤痕发生率分别为16.0%(8/50)和86%(43/50),P<0.05。因此,LSO入路患者审美完全满意度高于翼点入路(P＜0.05)。结论 LSO入路可以为视交叉旁脑膜瘤提供一个安全、快速、侵入性更小的暴露方式,可作为翼点入路的合理替代方法。

关键词: 眶外侧(LSO)入路, 翼点入路, 视交叉旁脑膜瘤, 显微手术, 手术结局, 美学效果