经颅入路切除颅眶和颅鼻沟通瘤的探讨

Transcranial Approach for Resection of Tumors in Area of the Anterior Skull Base, Orbit and Paranasal Sinuses

目的 探讨经颅入路切除前颅底 --眶、副鼻窦沟通瘤的可行性及并发症。方法 对 2 0 0 0 -0 7～ 2 0 0 1-0 4,采用单纯经颅入路切除广泛累及前颅底眶内和副鼻窦肿瘤 9例进行回顾性分析 ,其中颅底 --眶内肿瘤 4例 ,颅底 --副鼻窦、眶内肿瘤 5例。结果 所有病例均做到病变全切 ,术后发生脑脊液漏 1例 ,上睑轻度下垂 2例 ,随访 2 0～ 2 9个月 ,1例术后 1年死于复发 ,8例无瘤生存。结论 单纯经颅入路能切除累及前颅底、眶内、副鼻窦的广泛肿瘤 ;眶顶骨膜的剥离可致提上睑困难而影响美容 ,因此尽量不用扩展的入路 ;

Objective To investigate the feasibility and complications of the transcranial approach for resection of tumors that involve the anterior skull base, orbit and paranasal sinuses. Methods Nine cases of tumors involving the anterior skull base, orbit and paranasal sinuses, which were resected by transcranial approach alone in our hospital from July 2000 to April 2001, were retrospectively analyzed. All patients had the lesion of the anterior skull base and orbit, and 5 cases had additional paranasal sinuses involvement. Results The tumors in all patients were removed completely. Complications occurred in three cases, including one case of cerebrospinal fluid leaking and two cases of blepharoptosis. One died of tumor recurrence one year after operation. Eight were tumor-free survival during the follow-up period of 20～29 months. Conclusion The transcranial approach can completely remove the tumors widely invading the anterior skull base, orbit and paranasal sinuses. Separation of the periosteum of the orbital roof can cause blepharoptosis, which leads to failure of cosmetics. Extending approach must be avoided if it is possible. The reconstruction of the skull base with pedicle pericranial flap may be the key factor to reduce complications.