前中颅底沟通瘤的手术入路和显微切除

Approach and microsurgery in removing communicative tumors invading both anterior and middle skull base

目的 探讨前中颅底沟通瘤的手术入路和颅底重建的方法。方法 采用经额鼻筛眶入路、经额颞眶颧入路和经额颞联合耳前颞下入路暴露肿瘤,予以显微手术切除。结果 27例该部位肿瘤施行显微手术治疗,肿瘤全切除21例,次全切除3例,大部分切除3例。手术结果良好,无手术死亡及严重并发症。结论 前中颅底内外沟通瘤应根据肿瘤位置、侵犯范围选择适当手术入路,充分暴露病灶,有利于广泛切除肿瘤。颅底重建是避免脑脊液漏及颅内感染的关键。

Objective To investigate surgical approaches and the methods of skull base reconstruction for the communicating tumors invading both anterior and middle skull base. Methods The fronto-naso-ethmoido-orbital approach, fronto-tomporo-orbito -zygomatic approach and combined fronto -tomporo -preauricular subtempporal approach were adapted to expose tumors which were resected by microsurgery. Results 27 cases with the communicative tumors invading both anterior and middle skull base received microsurgical therapy. The tumors were totally removed in 21 cases (77.7 %), subtotally in 3 and mostly in 3 cases. The operative results were good, without operative mortality and serious complication. Conclusion Depending on location and invading extension of tumor, different approaches are selected, which can provide excellent exposure and allow for an aggressive resection of the tumor. Skull base reconstruction is the key to the avoidance of craniocerebral fluid leak and infection.