KẾT QUẢ PHẪU THUẬT U TẦNG TRƯỚC NỀN SỌ BẰNG PHẪU THUẬT LỖ KHOÁ TRÊN CUNG MÀY

Abstract

Objective: Evaluation of microsurgery results of eyebrow keyhole approach for anterior cranial base tumors. Methods: An interventional study based on 65 patients with anterior cranial base tumors. All patients were diagnosed and treated at Viet Duc Hospital from 1/2017 to 12/2020. Patients are selected with the following criteria: the investigator directly examines, reads computed tomography and magnetic resonance, participates in surgery and post-operative treatment, follow-up and postoperative evaluation with postoperative magnetic resonance imaging. Results: A total of 65 patients were treated, including 49 females and 16 males. There were 33 cases of meningioma, 14 Rathke cysts, 8 pituitary tumors, 8 craniopharyngiomas, 1 arachnoid cyst and 1 dermoid cyst. The youngest age was 5 and the highest was 76. History of previous tumor treatment in 8 patients (6 surgery and 2 radiosurgery) and history of chronic disease in 32.3%. The duration from first symptoms to surgery ranges from 1-10 years. The most common symptoms were headache (96.9%), blurred vision (67.7%), hemianopia in the left eye (43.1%) and hemianopia in the right eye (41.5%). All patients underwent magnetic resonance imaging, 51 patients with tumor size  3cm; and 14 cases >3cm. The largest tumor is 6cm and the smallest is 1.23cm. Pathological results: 33 meningiomas, 14 Rathke cysts, 8 pituitary tumors, 8 craniopharyngiomas, 1 arachnoid cyst and 1 dermoid cyst. Gross total resection 73.8%; subtotal 21.5%; partial 0.3% and biopsy 0.1%. One case of tumor recurrence after 1 year, 1 osteomyelitis, 1 wound infection. Postoperative hypopituitarism 9 patients, 6 patients after 6 months and 3 patients after 12 months. Assessment according to the Vancouver Scar Scale: excellent 89.7%; good 6.9%; moderate 1.7% and minimum 1.7%. The results of bone healing were good and moderate in 96.6% and poor healing in 3.4%. Results after 1 year: 81% fully recovered, 15.5% symptomatic such as headache, diabetes insipidus. No death, no serious sequelae and 98.3% of patients returned to normal labor activities. Conclusion: The eyebrow keyhole approach is an effective surgery, the rate of gross total resection and subtotal resection is over 90% for all types of tumors. The rate of complications, morbidity and mortality are low.