31例硬脑膜颅底重建的颅鼻沟通瘤临床分析

Clinical analysis of resection and dura skull base reconstruction of cranionasal communication tumor in 31 cases

目的探讨颅鼻沟通瘤切除与硬脑膜颅底修复重建方法。方法收集2018-2022年接受颅鼻沟通瘤切除术后行硬脑膜颅底重建的31例患者的临床资料,并随访3~41个月。结果总计31例患者,其中男20例,女11例;年龄19~74岁,中位年龄57岁。良性病变17例(血管瘤、Rathke囊肿、鳞状上皮乳头状瘤、颅咽管瘤各1例,脑膜脑膨出、内翻性乳头状瘤、脑膜瘤Ⅰ级各2例,神经鞘瘤3例,垂体瘤4例),恶性病变14例(骨肉瘤、低分化癌各1例,内翻性乳头状瘤恶变、嗅神经母细胞瘤、腺癌、腺样囊性癌各2例,鳞癌4例)。鼻内镜联合颅面切口16例,单纯鼻内镜手术15例。31例患者均行肿物手术全切及硬脑膜颅底重建,游离组织修复8例(阔筋膜5例,鼻腔黏膜3例);带蒂皮瓣修复23例(单纯鼻中隔黏膜瓣11例,鼻中隔黏膜瓣联合游离移植物6例,帽状腱膜联合游离移植物6例);31例患者中有8例行颅底骨性修复。术后脑出血1例,脑脊液漏1例,颅内感染2例,治疗后均顺利出院。放疗后脑脊液漏伴颅内感染1例,保守治疗康复。17例良性病变患者均生存;14例恶性患者术后13例行放疗,9例无复发生存;5例复发,其中2例带瘤生存,1例再次手术,2例死亡。结论颅鼻沟通瘤是前中颅底的高危疾病,肿物完整切除后修复方式多种多样,良好的修复重建及多学科协作对患者的预后至关重要。

Objective To explore the methods of resection,dura and skull base repair and reconstruction of cranionasal communication tumor.Methods Data of 31 patients with cranionasal communication tumor who underwent dura and skull base reconstruction after tumor resection from 2018 to 2022 were collected.Follow-up lasted for 3 to 41 months.Results A total of 31 patients were enrolled,including 20 males and 11 females.The ages ranged from 19 to 74 years,with a median age of 57 years old.There were 17 benign lesions(one case of hemangioma,one case of Rathke cyst,one case of squamous papilloma,one case of craniopharyngioma,two cases of meningocele,two cases of varus papilloma,two cases of meningioma of gradeⅠ,three cases of schwannoma,four cases of pituitary tumor)and 14 malignant lesions(one case of osteosarcoma,one case of poorly differentiated carcinoma,two cases of varus papilloma malignancy,two cases of olfactory neuroblastoma,two cases of adenocarcinoma,two cases of adenoid cystic carcinoma,four cases of squamous cell carcinoma).Sixteen cases underwent nasal endoscopy combined with craniofacial incision and 15 cases underwent nasal endoscopy surgery alone.Complete resection of the mass and dura and skull base reconstruction were performed in all 31 patients,and free graft repair was performed in 8 cases(fascia lata in 5 cases and nasal mucosa in 3 cases).Twenty-three cases were repaired with pedicled flaps(septal mucosal flap alone in 11 cases,septal mucosal flap combined with free graft in 6 cases,and cap aponeurosis combined with free graft in 6 cases).Eight out of 31 patients underwent skull base bone repair.Postoperative cerebral hemorrhage occurred in 1 case,cerebrospinal fluid leakage in 1 case,intracranial infection in 2 cases.All patients were successfully treated without severe sequelae.Cerebrospinal fluid leakage and intracranial infection occurred in one patient after radiotherapy,who recovered after conservative treatment.All 17 patients with benign lesions survived.Thirteen out of 14 patients with malignant lesions received radiotherapy after surgery,nine survived without recurrence,five cases recurred,of which 2 survived with tumor,one underwent reoperation and 2 died.Conclusion Cranionasal communication tumors are high-risk diseases of anterior and middle skull base,and various surgical repair methods could be selected after complete resection of the tumor.Successful reconstruction and multidisciplinary cooperation are crucial for treatment outcome.