鼻腔鼻窦肿瘤侵犯前颅底的手术治疗

Surgical treatment of nasosinus tumor involving base of the anterior cranial fossa

目的 :探讨鼻腔鼻窦肿瘤侵犯前颅底的手术方法。方法 :经眉弓额窦前径路切除侵犯前颅底的鼻腔、鼻窦肿瘤 14例 ,7例前颅底骨质破坏直径在 2cm以下 ,硬脑膜完整者未行前颅底修复 ;7例既有前颅底骨质破坏 ,又有硬脑膜缺损且直径在 2 .5cm以上者 ,以带蒂额肌骨膜瓣、帽状腱膜额骨膜瓣或带蒂颞肌筋膜骨膜瓣修复。结果 :术后随访 1～ 8年 ,11例恶性肿瘤中 ,2年存活 1例 ,3年存活 6例 ,4年存活 2例 ,术后 2年内死亡 2例 ;3例良性肿瘤均健在。所有病例均未发生颅内外感染、脑脊液漏及脑膜脑组织膨出。结论 :该术式接近病变部位 ,各鼻窦暴露满意 ,可直视下进行手术操作 ,并减轻了对额叶的牵拉作用 ,修补脑膜及止血均方便 。

Objective:To eaplore the operative approach for nasosinus tumors involving the base of the anterior cranial fossa.Method:Seven cases with defects,diameter less than 2 cm, on the skull base without damage of the duramater were not repaired. Other 7 cases with defects,diameter more than 2.5 cm, on both the skull base and duramater were covered with frontalis muscle flap or temporalis fascia flap.Result:Following up 1～8 year. 6 of the 11 malignant tumors survived after 3 years and 2 cases did after 4 years;3 cases of benignant tumors are still alive. neither meningoephalocele nor cerebrospinal fluid fistula and extracranial or intracranial infection occurred.Conclusion:This operative mode is closer to the tumor and easy to repair duramater and stop bleeding,and has fine exposure of every nasal sinus, minimal retraction of the frontal lobe.If diameter of defect is more than 2 cm on the skull base, the reconstruction is necessary.