颅底重建方法及材料的选择

The selection of methods and materials in skull base reconstruction

目的探讨颅底重建的必要性、原则及方法和材料的选择，提高颅底手术疗效，降低并发症。方法回顾性分析14例颅底重建病例，其中前颅底重建3例，中颅窝及侧颅底重建11例，应用钛板修复颅底骨性缺损3例。结果14例患者术后均随访6个月以上。1例于术后3周出现脑脊液漏、颅内感染，随访6个月时Karnofsky评分40分。1例出现面神经损伤，术后2个月痊愈。其余患者均未出现脑脊液漏、颅内外感染、移植皮瓣坏死等相关并发症。结论颅底重建是颅底外科的重要部分，硬膜重建尤为重要。根据缺损组织、缺损部位及大小选择恰当的重建方法及材料，兼顾功能及美观，可提高颅底外科手术疗效，降低并发症。

Objectives To explore the necessity, principles, selection of methods and materials of skull base reconstruction. To improve the efficacy of skull base surgery and decrease the surgery related complications. Methods 14 cases （3 cases of anterior skull base reconstruction and 11 cases of lateral skull base and related middle cranial fossa reconstruction） of skull base reconstruction were retrospectively analyzed. Titanium was used to repair the bony defect in 3 cases. Results All the cases were followed-up more than six months. Cerebral spinal fluid leakage and intracranial infection occurred in 1 patient in 3 weeks after operation and was cured with Karuofsky score of 40 after six months. Facial nerve injury occurred in 1 case and recovered completely after two months. The postoperative courses were uneventful in the else 12 cases without any surgery related complications such as cerebral spinal fluid leakage, infection or necrosis of transferred tissue etc. Conclusions Skull base reconstruction is integral to the skull base surgery, and the duraplasty in watertight style is the paramount part of the reconstruction procedures. The selection of the optimal reconstruction method and materials according to the tissue, size and site of defect with concerning not only functions but also cosmetics, can improve the efficacy of skull base surgery and decrease the surgery related compilations.