经额窦额部开颅在颅前窝和鞍区肿瘤中的应用

Application of trans-frontal sinus frontal craniotomy for anterior cranial fossa and sellar tumors

目的总结经额窦额部开颅在累及颅前窝和鞍区肿瘤中的应用体会。方法回顾性分析16例累及颅前窝和(或)鞍区肿瘤的开颅经验。采用将整个额窦前壁与额部骨瓣一体化开颅的方法,以增加颅底暴露范围,减少额叶牵拉和便于手术早期切断肿瘤血运。结果术后病理:脑膜瘤10例,颅咽管瘤2例,节细胞胶质瘤1例,软骨瘤1例,额筛骨瘤合并鼻源性囊肿1例,成熟畸胎瘤1例。肿瘤全切除15例,次全切除1例。无手术入路相关性并发症发生。结论经额窦额部开颅可充分暴露颅前窝,并可满意暴露侵犯颅底、鼻旁窦的肿瘤,具有脑组织牵拉轻,可以早期切断肿瘤血运的优点,且降低颅前窝重建的复杂性。

Objective To summarize the experience of trans-frontal sinus frontal craniotomy for tumors involving the anterior cranial fossa and/or sellar region. Methods Surgical data and experiences of trans-frontal sinus frontal craniotomy for tumor involving the anterior cranial fossa and sellar region in 16 patients were analyzed and summarized retrospectively. The frontal sinus anterior wall and frontal bone flap were removed en bloc to increase exposure of skull base, reduce drag to frontal lobe, and cut of the tumor blood supply in early period of the operation. Results Postoperative pathology revealed the tumor was meningiomas in 10 cases, craniopharyngiomas in 2, ganglioglioma in 1, chondroma in 1, frontoethmoidal sinus osteoma with mucocele in 1, and mature teratoma in 1. The tumor was totally removed in 15 patients and subtotally in 1. There was no approach-related complication in the group. Conclusion The trans-frontal sinus frontal craniotomy can provide wide exposure of the anterior cranial fossa and satisfactorily expose the tumor in the paranasal sinus adjacent to the anterior cranial fossa. It has also the advantages of less brain retraction, early devascularization of the tumor, and easy anterior skull base reconstruction.