前中颅凹底大型内外沟通瘤的显微切除

Approach and microsurgery to remove neoplasm invading both intracranium and extracranium at anterior and middle skull base

目的为了提高切除前或／和中颅凹底大型颅内外沟通性肿瘤的手术效果。方法分别采用颅面联合入路、额颞－颞下窝入路或额颞－颞下窝结合面前径路暴露肿瘤，给予显微手术切除。结果２３例肿瘤全切除１１例，次全切除９例，大部切除３例。无手术死亡及严重并发症。结论（１）前或／和中颅凹底内外沟通性肿瘤应根据肿瘤大小、位置及侵犯范围选择颅面联合入路、额颞－颞下窝入路或额颞－颞下窝入路结合面前径路即可给于充分暴露并能在直视下广泛切除肿瘤；（２）中颅凹底侵及海绵窦和破裂孔部的肿瘤应在较高放大倍数手术显微镜下仔细分离切除；

Objective To remove the neoplasm invading both intracranium and extracranium at the anterior and middle skull base. Method The combined cranniofacial approach, the frontotemporal infratemporal fossa approach and the frontotemporal infratemporal fossa approach combining anterior facial approach were adapted to expose tumors which were resected by microsurgery Result Twenty three cases were resected, of which total resection for 11 cases, sub total 9 and mostly 1 case There was no serious operative complication and the surgical mortality was zero Conclusion (1) Depending on location, size and invading extension of the tumor, above different approaches are adapted selectively which can provide excellent exposure and allow for an aggressive resection of the tumor (2) The tumor tissue of the cavenous sinus and foramen lacerum is resected carefully by microsurgery (3) The dural deficiecy must be repaired and sutured tightly to avoid craniocerebral fluid leak