微創手術切除鞍結部腦膜瘤

10.6666/ClinMed.202105_87(5).0050

陳捷一；張軒侃；顏玉樹

蝶竇內視鏡手術（tuberculum sellar meningioma） ； 鎖孔手術（transsphenoidal endoscopic surgery, keyhole surgery）

臨床醫學月刊

87卷5期（2021 / 05 / 28）

298 - 302

繁體中文

鞍結部腦膜瘤（tuberculum sellae menigioma）是從鞍結部原發的腦膜瘤，雖然絕大部分為良性，但因鄰近視神經（optic nerve），容易因壓迫視神經造成病人視力缺損甚至是失明。鞍結部腦膜瘤位於腦部深處，且腫瘤四周可能沾黏重要的顱內血管，手術目標為解除對視神經的壓迫及在安全的範圍內盡量將腫瘤切除乾淨，以減少復發的機會。早期神經外科以傳統開顱切除腫瘤，但手術傷口較大，病人術後所需回復時間較長。近年來則分別有鎖孔手術（keyhole surgery）及經鼻經蝶竇內視鏡手術（transsphenoidal endoscopic surgery）等微創手術技術的發展。鎖孔手術是透過一個病人眉毛處五公分左右的手術傷口，以“迷你＂開顱手術來移除鞍結部或附近的病灶，有傷口小、對腦部的牽拉少，病人術後復原快、住院時間較短等優點。經鼻經蝶竇內視鏡手術則經由鼻孔蝶竇從內側抵達腫瘤的根部，截斷腫瘤的血液供應再慢慢移除腫瘤，此手術還有傷口藏在鼻孔內，病人手術後外觀沒有傷口，不用牽拉腦部，術後恢復也很快等優點。隨著神經外科技術的發展，手術醫師更能運用多元的方式，透過最小最精準的手術傷口給病人帶來更好的手術成果。

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