前颅底肿瘤的手术入路与颅底重建的临床探讨

Surgical approaches of anterior skull base tumors and skull base reconstruction in patients with anterior skull-based tumors

目的探讨前颅底肿瘤的手术入路及颅底重建的价值。方法回顾性分析浙江省肿瘤医院神经外科自1994年9月至2008年6月行手术切除并行颅底重建的47例前颅底肿瘤患者的临床资料，其中采用前颅底入路7例，扩大前颅底入路8例，颅面联合入路32例，且采用颅骨膜瓣、颅骨膜额肌瓣为主的颅底修复技术。结果本组肿瘤全切率为70．3％（33／47），大部分切除率为25．5％（12／47），部分切除率为4．2％（2／47）；并发症发生率为21．2％（10／47）。结论三种入路能完成各型前颅底肿瘤切除；运用骨膜瓣、颅骨膜额肌瓣为主的颅底修复技术安全有效，并发症少，对术后放疗有很好的放疗耐受性。

Objective To demonstrate various operative approaches to the removal of the tumors involving the anterior skull base and explore the effectiveness of the pericranial flap in reconstructing the anterior skull base. Methods The clinical data of 47 patients with anterior skull- based tumors were retrospectively reviewed and analyzed： subfrontal approach, extended subfrontal approach and combined craniofacial approaches were performed in 7, 8 and 32 patients, respectively; pericranial flap and galeo-pericranial flap were employed in the reconstructing the anterior skull base. Results Tumors were radically resected in 33, subtotally resected in 12 and partly resected in 2 patients with 21.2% overall complication rate. Conclusion The 3 approaches are highly effective in the removal of anterior skull-based tumors. The pericranial flap or galeo-pericranial flap was reliably and effectively used in the reconstructing anterior skull base with minimally complication rate and excellent endurance of postoperative radiotherapy.