Cherekaev V A, Reshetov I V, Belov A I, Zaĭtsev A M
Zh Vopr Neirokhir Im N N Burdenko. 2004 Apr-Jun(2):10-4; discussion 14-5.
The study was a result of joint studies conducted by the Academician N. N. Burdenko Research Institute of Neurosurgery, Russian Academy of Medical Sciences, and the P. A. Herzen Moscow Cancer Research Institute, Ministry of Health of the Russian Federation, in 1996 to 2001. During this period, the joint team operated on 32 patients with malignant craniofacial tumors. Of them there were 18 males and 14 females whose age was 8 to 74 years. Most patients were aged 36 to 60 years. Epithelial tumors were predominant in the histological pattern of 18 (56%) patients. Squamous-cell (8 patients) and adenoid cystic (4 patients) carcinomas were prevalent among the epithelial tumors and rhabdomyosarcoma (4 patients) was prevalent among the mesenchymal tumors. Craniofacial block-resection was one of the stages of complex treatment in patients with malignant tumors of the base of the skull. Malignant craniofacial tumors are prone to local spread and rarely give rise to both regional and distal metastases. This is the basis for the concept that the patient may be cured via block removal of a tumor with a portion of its adjacent intact tissues in a combination with pre- and/or postoperative multidrug and radiation therapies. There were intraoperative and postoperative fatal cases. The signs of tumor remnants were absent, as evidenced by computed tomography and magnetic resonance imaging (MRI) performed in all cases. Further control MRIs were performed every 3 months during 2 years, then every 6 months, Complications as graft rejection were observed in 2 cases: on day 2 after surgery in one case and on day 6 in the other. They were not a cause of liquorrhea and meningitis due to the effectiveness of a pedicle periosteal graft that restricts the dura matter. Repeated microsurgical operations using other types of grafts. The patients were followed up for 3 to 5 years. During this period, 12 (37.5%) patients died of dissemination in the period of 1 month to 2 years; 1 (3.1%) patient died of the causes unassociated with the underlying pathological process. In 7 (21.8%) patients, the relapse-free was 5 years or more; of them there were 5 patients with epithelial tumors, 1 with a mesenchymal tumor, and 1 with a malignant chondroid tumor. In these patients, cosmetic corrective operations were made by plastic surgeons. Twelve patients, including 5 with epithelial tumors, 4 with mesenchymal tumors, and 3 with chondroid ones, were operated on for recurrences. Seven patients underwent lymphadenectomy due to the cervical lymph nodal metastases. Nineteen (59.4%) and 17 (53.1%) patients survived > or = 3 and > or = 5 years, respectively.
该研究是俄罗斯医学科学院N. N. 布尔坚科院士神经外科研究所与俄罗斯联邦卫生部P. A. 赫尔岑莫斯科癌症研究所于1996年至2001年联合开展研究的成果。在此期间，联合团队为32例恶性颅面肿瘤患者实施了手术。其中男性18例，女性14例，年龄在8岁至74岁之间。大多数患者年龄在36岁至60岁之间。在18例（56%）患者的组织学类型中，上皮性肿瘤占主导。在上皮性肿瘤中，鳞状细胞癌（8例）和腺样囊性癌（4例）较为常见，间叶性肿瘤中横纹肌肉瘤（4例）较为常见。颅面整块切除术是颅底恶性肿瘤患者综合治疗的阶段之一。恶性颅面肿瘤易于局部扩散，很少发生区域和远处转移。这就是认为通过整块切除肿瘤及其部分相邻完整组织，并结合术前和/或术后多药治疗及放疗，患者可能治愈的理念基础。有术中及术后死亡病例。所有病例经计算机断层扫描和磁共振成像（MRI）证实，均无肿瘤残留迹象。术后2年内每3个月进行一次MRI复查，之后每6个月复查一次。观察到2例发生移植物排斥等并发症：1例在术后第2天，另1例在术后第6天。由于带蒂骨膜移植物对硬脑膜的限制作用，它们并非导致脑脊液漏和脑膜炎的原因。使用其他类型移植物进行了重复显微手术。对患者进行了3至5年的随访。在此期间，12例（37.5%）患者在1个月至2年内死于肿瘤播散；1例（3.1%）患者死于与基础病理过程无关的原因。7例（21.8%）患者无复发存活5年或更长时间；其中上皮性肿瘤患者5例，间叶性肿瘤患者1例，恶性软骨样肿瘤患者1例。整形外科医生对这些患者进行了美容矫正手术。12例患者因复发接受了手术，其中上皮性肿瘤患者5例，间叶性肿瘤患者4例，软骨样肿瘤患者3例。7例患者因颈部淋巴结转移接受了淋巴结切除术。分别有19例（59.4%）和17例（53.1%）患者存活≥3年和≥5年。
