不同手术入路治疗前颅底沟通性肿瘤23例

Surgical treatment of 23 communicating tumors on anterior skull base via 3 different approaches

目的总结前颅底沟通性肿瘤的3种手术切除与修复方法。方法采用颅面联合径路对16例鼻腔鼻窦颅沟通性肿瘤、鼻-眶-颅沟通性肿瘤切除,并同期行带蒂额肌帽状腱膜裂层颅骨瓣修复;3例眶颅沟通性肿瘤行额下进路手术切除,并行颞肌筋膜修补;4例经翼点入路,颞肌筋膜修补。结果术后2例发生脑脊液漏,经对症治疗好转,未发生颅内感染。2年生存16例,3年生存7例,5年以上存活4例。结论颅面联合径路、额下径路、翼点入路进行前颅底沟通性肿瘤切除,加以带蒂额肌帽状腱膜裂层颅骨瓣、颞肌筋膜瓣修复,切除范围安全、彻底,修复方便、可靠,是一种较为理想的手术切除及修复方法。

Objective To summarize three different surgical resection and repair approaches for communicating tumors on the anterior skull base. Methods Sixteen cases of cranio-nosal and cranioorbital-nosal communicating tumors were surgically treated via compound craniofacial approach. The surgical defects of anterior skull base were repaired with a compound pedicellar frontal galea muscle flap. Three cases of cranio-orbital communicating tumors were treated via subfrontal approach, and 4 cases via pterygoid point approach; their defects of anterior skull base were repaired with temporalis myofascial flap. Results CSF leakage occurred in 2 cases, and got improved through allopathic treatment without intracranial infection. Of all the cases, 16 survived for 2 years, 7 for 3 years, and 4 for more than 5 years.Conclusion. Compound craniofacial approach, subfrontal approach, and pterygoid point approach are relatively safe and effective resection mathods for communicating tumors on the anterior skull base. The defects of anterior skull base can be repaired with the compound pedicellar frontal galea muscle flap or temporalis myofascial flap.