Cherekaev V A, Korshunov A G, Kornienko V N, Bekiashev A Kh, Belov A I, Vinokurov A G, Tsikarishvili V M, Kadasheva A B, Smirnov R A
Zh Vopr Neirokhir Im N N Burdenko. 2004 Oct-Dec(4):6-11; discussion 11-4.
From 1997 to 2004, the Academician N. N. Burdenko Research Institute of Neurosurgery has operated on 54 patients with intracranial meningiomas spreading into the infratemporal fossa. Fifteen patients were operated on for the first time. Thirty-nine patients had undergone surgical interventions on the average 3 times (from 2 to 8). All the patients were operated on via different orbitozygomatic approaches depending on the extent of the process. Opening the upper and lower palpebral fissures and the round foramen with resection, if required, the pterygoid processes suffice to remove tumors from the areas of the upper and lower palpebral fissures, which spread into the sphenoid and maxillary sinuses. If there are tumors at the site of the base of the anterior surface of the pyramid, and the articular bursa, it is expedient to open the oval and spinous foramens, to resect the external portions of the fundus of the middle cranial fossa and, if required, the articular process of the lower jaw. By taking into account the X-ray and histological patterns, it may be stated that invasion of meningiomas is not always accompanied by the development of hyperostosis. According to our findings, extracranial growth of meningiomas points to the invasion of osseous structures of the middle cranial fossa. Furthermore, if meningiomas grow into the infratemporal fossa, they frequently involve the muscles, nerves, and mucosa. After removing the tumors spreading to the infratemporal fossa, the optimum plastic repairs of defects of the base of the skull are as follows: hermetic closure of basal defect of the dura mater with a free fat flap, by fixing it with sutures and fibrin-thrombin glue with additional plastic repair of skull base defect with local displaced tissues on a pedicle (with a temporal muscular fascioperiosteal flap, a Bisch fat flap). Further policy of management of these patients is a complicated problem. It depends on the radicalism of an operation and the invasiveness of the process. The histobiological features of infiltrative meningiomas should be studied and this will determine management policy. Conceivably, the use of postoperative radiation therapy will be substantiated in a definite group of patients.
1997年至2004年期间，苏联科学院院士N. N. 布尔坚科神经外科研究所为54例颅内脑膜瘤侵犯颞下窝的患者实施了手术。15例患者为首次手术。39例患者平均接受过3次手术（2至8次）。所有患者均根据病情范围采用不同的眶颧入路进行手术。打开上下睑裂和圆孔，必要时切除翼突，足以切除侵犯蝶窦和上颌窦的上下睑裂区域的肿瘤。如果在岩尖前表面基部和关节囊处有肿瘤，则宜打开卵圆孔和棘孔，切除中颅窝底的外部部分，必要时切除下颌关节突。综合X线和组织学表现，可以认为脑膜瘤的侵犯并不总是伴有骨质增生。根据我们的研究结果，脑膜瘤的颅外生长表明中颅窝骨结构受到侵犯。此外，如果脑膜瘤生长到颞下窝，它们经常累及肌肉、神经和黏膜。切除侵犯颞下窝的肿瘤后，颅骨底部缺损的最佳整形修复方法如下：用游离脂肪瓣严密缝合硬脑膜基部缺损，用缝线和纤维蛋白凝血酶胶固定，并用带蒂局部移位组织（颞肌筋膜骨膜瓣、比施脂肪瓣）对颅骨底部缺损进行额外的整形修复。这些患者的进一步治疗策略是一个复杂的问题。这取决于手术的彻底程度和病情的侵袭性。应研究浸润性脑膜瘤的组织生物学特征，这将决定治疗策略。可以想象，在特定的患者群体中，术后放疗的应用将得到证实。
