Gil Ziv, Constantini Shlomo, Spektor Sergey, Abergel Avraham, Khafif Avi, Beni-Adani Liana, Leonor Trejo-Leider, DeRowe Ari, Fliss Dan M
Skull Base Surgery Unit and the Department of Otolaryngology, Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel-Aviv 64239, Israel.
Head Neck. 2005 Aug;27(8):682-9. doi: 10.1002/hed.20226.
This study aimed to examine the surgical, oncologic, and developmental results of infants and children undergoing extirpation of skull base tumors.
Sixty-seven children aged 0.5 to 18 years (mean, 11 years) who were operated on during a 6-year period made up the study cohort. Eighteen cases (27%) involved malignant tumors, and 49 (73%) involved benign tumors. The most common benign tumors were craniopharyngioma (n = 10) and juvenile nasopharyngeal angiofibroma (n = 8). The most common malignant tumor was sarcoma (n = 5). Thirty-six tumors (55%) involved the anterior skull base, and the rest involved the lateral (n = 24) and posterior (n = 7) skull base. Subcranial, transfacial, and subfrontal approaches were used for extirpation of anterior skull base tumors. Voluminous or malignant tumors were excised by use of combined approaches (subcranial-transfacial, subcranial-degloving, or pterional-degloving). Twenty-two children underwent adjuvant therapy (chemotherapy, radiation, or both). Postoperative follow-up was 3 to 60 months.
No severe postoperative complications (ie, meningitis, cerebrospinal fluid leak, tension pneumocephalus) and no perioperative mortality occurred. Two and a half years later, 54 of the children (80%) are alive and well. Five children, two with optic glioma and one each with squamous cell carcinoma, ependymoma, and germinoma, have died of their disease. The subcranial approach had no cosmetic impact on the craniofacial development of the patients.
The extirpation of skull base tumors by use of conventional surgical techniques is feasible and safe among infants and children. The complication and mortality rates are lower than those in adults. The long-term cosmetic effect of the subcranial approach is negligible.
本研究旨在探讨接受颅底肿瘤切除手术的婴幼儿及儿童的手术、肿瘤学及发育结果。
67名年龄在0.5至18岁（平均11岁）的儿童在6年期间接受了手术，构成了研究队列。18例（27%）为恶性肿瘤，49例（73%）为良性肿瘤。最常见的良性肿瘤是颅咽管瘤（n = 10）和青少年鼻咽血管纤维瘤（n = 8）。最常见的恶性肿瘤是肉瘤（n = 5）。36例肿瘤（55%）累及前颅底，其余累及侧颅底（n = 24）和后颅底（n = 7）。采用颅下、经面部和额下入路切除前颅底肿瘤。体积较大或恶性肿瘤采用联合入路（颅下 - 经面部、颅下 - 掀翻术或翼点 - 掀翻术）切除。22名儿童接受了辅助治疗（化疗、放疗或两者皆有）。术后随访3至60个月。
未发生严重术后并发症（即脑膜炎、脑脊液漏、张力性气颅），也无围手术期死亡。两年半后，54名儿童（80%）存活且状况良好。5名儿童死亡，其中2名患有视神经胶质瘤，1名分别患有鳞状细胞癌、室管膜瘤和生殖细胞瘤。颅下入路对患者颅面发育无美容影响。
在婴幼儿及儿童中，采用传统手术技术切除颅底肿瘤是可行且安全的。并发症和死亡率低于成人。颅下入路的长期美容效果可忽略不计。
