前颅底缺损重建的长期临床随访

The long-term follow-up results of the dural reconstruction without bone graft at the anterior skull-base defect.

目的随访观察５０例前颅底缺损重建病例的长期疗效。方法手术中前颅底缺损只重建硬脑膜不行骨移植，术后定期临床随访及行ＣＴ、ＭＲＩ检查。结果５０例病人的前颅底骨缺损范围为：前后径２～６ｃｍ（平均３５ｃｍ），左右径２～５ｃｍ（平均２８ｃｍ），随访时间为３个月至５年（平均２年），均未发生脑脊液漏和脑膜脑膨出现象，其中３２例病人得到ＣＴ或ＭＲＩ证实。结论手术中只要将颅底正常硬脑膜修补完整，或选用力学性能接近甚至超过正常硬脑膜的材料进行修补，再辅以带蒂颅骨膜瓣等方法加强颅底重建后，术后颅内压不高，在通常的颅底缺损范围内（缺损直径不超过４ｃｍ），一般不会发生脑膜脑疝出，不必行颅底骨移植。

Objective To conduct a long-term follow-up of 50 patients with the anterior skull-base defects in whom the dural were reconstructed without bone grafts. Methods At anterior skull-base defect,the dural reconstruction was reinforced by a pedicled pericranial flap without a free bone graft.CT and MRI examinations were taken regularly after operation. Results Among 50 cases of anterior skull-base defects with the longitudinal size from 2cm to 6cm (average 3 5cm )and the transversal size from 2cm to 5cm (average 2 8cm ),the long-term follow-up study which duration ranged from 3 months to 5 years (average 2 years)showed no evidence of CSF leakage and encephalomeningocele. It was comfirmed by CT or MRI among 32 cases.Conclusions Under normal intracranial pressure, if the dura mater is repaired properly at the skull-base defect and reinforced by a pedicled pericranial flap,an encephalomeningocele can be prevented.It is not necessary to take free bone graft when the size of cranial base bone defect is smaller than or equal to 4cm .