颅面联合入路在颅底沟通性肿瘤中的应用

Combined craniofacial approach for the treatment of skull base communicating tumor

目的探讨颅面联合入路在颅底区沟通性肿瘤治疗中的方法和疗效。方法回顾性分析我院44例经颅面联合入路手术治疗颅底区沟通性肿瘤患者资料,经病理证实恶性肿瘤31例,良性肿瘤13例。位于前颅底区35例,累及前、中颅底区9例。肿瘤切除后造成的硬脑膜缺损用自体组织严密修补,并用额部带蒂复合组织瓣行颅底区组织缺损修复。结果肿瘤全切38例,次全切除3例,部分切除3例,无手术死亡病例。并发症包括脑神经损伤3例,伤口感染2例,出现暂时性脑脊液漏2例,一过性精神症状2例。随访1~6年,10例死于肿瘤复发,失访2例。存活2年以上25例,3年以上17例。结论颅面联合入路是颅底区沟通性肿瘤外科治疗的主要手术入路之一,它是前颅底区（部分可以累及中颅底区）沟通性肿瘤较好的手术入路。

Objective To investigate the effect of the combined craniofacial approach for the treatment of skull base communicating tumor.Methods Clinical data of 44 patients with skull base communicating tumors resected via combined craniofacial approach in our hospital was reviewed retrospectively.The pathological examinatios showed 31 cases were malignant and 13 were benign.As for the location of the tumors,35 were located in anterior cranial base,and 9 cases involved both anterior and middle cranial base.The defects of dura mater were repaired with autologous tissue and the defects of skull base were repaired with compound pedicle frontal petal.Results Of all the 44 cases,38 were resected en-bloc,3 subtotally,and 3 partially,without death during surgery.The main complications included cranial nerve injuries（3 cases）,wound infections（2 cases）,temporary leakages of cerebrospinal fluid（2 cases）,and temporary psychiatric symptoms（2 cases）.All the patients were followed up for 1 to 6 years.Six patients died of regional recurrence and 4 of systemic metastasis;2 lost follow-up.25 patients had the survival time more than 2 years,and 17 more than 3 years.Conclusion The combined craniofacial apqroach is a main approach of the surgical treatment for skull base communicating tumor,especially for those involved the anterior and part of the middle cranial base region.