改良Mickey氏额颞-颞下窝入路结合面前径路切除中颅凹底大型内外沟通瘤

Modified Mickey's frontotemporal-infratemporal fossa approach combined with facial approach to remove large neoplasm of the middle skull base

目的：探讨采用经过改良Ｍｉｃｋｅｙ氏额颞－颞下窝入路结合面前径路（鼻侧切开或唇－上颌窦入路）切除中颅凹底大型内外沟通性瘤。方法：回顾分析我们１９９２年１月至１９９８年６月手术治疗的１６例患者。结果：成功切除了鼻咽癌６例，上颌窦腺鳞癌４例，脑膜瘤２例，血管纤维瘤２例，软骨肉瘤１例，尤文氏瘤１例。其中全切除６例，次全切除８例，大部切除２例。结论：１、该手术入路对向前、内侧侵及上颌窦、翼腭窝、筛窦及蝶窦的大型中颅凹底内外沟通瘤暴露充分，肿瘤得以广泛切除。２、采用改良的Ｍｉｃｋｅｙ氏额颞－颞下窝入路，复位后的额颞骨瓣由于来自颞肌血运保留，有利于骨瓣的成活及与正常颅骨的融合。同时颞肌在额颞骨附着点的保留，有利于术后患者咀嚼功能。

Objective: To evaluate removing of large neoplasm at both the base of the middle cranial fossa and the infratemporal fossa by modified Mickey's fro frontotemporal-infratemporal fossa approach combined with facial approach. Methods: Retrospectively analysing of 16 patients operated from January 1992 to June 1998 with above approach in our hospital was conducted. Results: A total of 16 cases (6 nasopharyngeal carcinomas. 4 maxillary adenosquamous carcinomas, 2 meningiomas. 2 angiofibromas, 1 chondrosarcoma and 1 Ewing's tumor) were resected satisfyingly, of which total remove for 6 cases, subtotal 8 and mostly 2. Conclusions: Modified frontotemporal - infratemporal fossa approach combined with facial approach provides excellent exposure and allows for an aggressive resection of the large neoplasm involving this region. The advantage of the modified approach is maintaining attaching point of the temporal muscle and blood supply from the muscle facilitating surviving of the frontotemporal bone and masticotory ability.