神经外科、头颈外科合作处理颅底沟通肿瘤

Management of Skull Base Tumors by Combined Head and Neck Surgery and Neurosurgery

背景与目的：颅底沟通肿瘤因其周围结构复杂而常需多学科合作处理。本研究探讨头颈外科与神经外科合作处理颅底沟通肿瘤的经验。方法：回顾性分析头颈外科和神经外科合作处理50例颅底沟通肿瘤的临床资料,其中前颅底16例,侧颅底11例,中央颅底17例,后颅底（颈静脉孔）6例。结果：肿瘤全切除44例,次全切除6例,其中良性肿瘤4例（垂体腺瘤3例、颈静脉孔区神经鞘瘤1例）,脊索瘤2例。无手术死亡和严重并发症。随访3-34个月,平均18个月。失访6例,肿瘤复发6例,再手术3例,伽玛刀治疗2例,放弃治疗1例。死亡1例,为恶性神经鞘瘤手术后5个月死于心肌梗塞。其余病例无症状性复发。结论：头颈外科医生和神经外科密切合作能提高颅底沟通肿瘤的手术疗效。

BACKGROUND ＆ OBJECTIVE： To deal with communicating skull base tumors needs collabration of different surgeries because of their complex peripheral structures. This study is to investigate the management of communicating skull base tumors by combined head and neck surgery and neurosurgery. METHODS： A retrospective review of 50 communicating skull base tumors managed by combined head and neck surgery and neurosurgery since Oct. 2005 in the Cancer Hospital of Chinese Academy of Medical Sciences was performed. Sixteen tumors were located in the anterior skull base, 11 cases in lateral skull base, 17 cases in the central skull base, and 6 cases in the posterior skull base. RESULTS： Total and subtotal resection of tumors were achieved in 44 cases and 6 cases respectively. No operative death, severe complications, and neurological deficits in this series were observed. Forty-four cases were followed up for 3 to 34 months with the average follow-up of 18 months. Six cases of malignant tumor recurred postoperatively. Among these 6 cases, reoperation was performed in 3 cases and gamma knife therapy was undergone in 2 cases. One patient with malignant neuronoma died of heart disease 5 months after the operation. CONCLUSIONS： To achieve a better prognosis, combined head and neck surgery and neurosurgery are recommended in the management of communicating skull base tumors.