Rong Bao-Gang, Chen Wei-Lun, Ding Yuan-Ping, Xie Guang, Chen Ying, Wang Tian-Duo
Department of Otorhinolaryngology, Qilu Hospital of Shandong University, Jinan 250012, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2005 Apr;40(4):291-4.
To discuss the best surgical approach to the skull base neoplasms.
Retrospective analysis the 79 skull base neoplasms cases treated with surgical resection in Qilu hospital of Shandong university from 1992 to 2002. Eleven surgical approaches including midfacial degloving, frontal coronal discission, nasal eversion, maxillary swing, partial maxillary resection, total resection of orbit, mandibular swing, combination of front, temple, preauricular, post aureum, neck, and transoral approaches were used to resect the tumor which involved fossae pterygopalatine, paranasal sinuses, nasopharynx, antero, meso and posterobasilar region, lobi frontalis and lobi temporalis of cerebrum.
Seventy-nine skull base neoplasms were totally removed and no one died from the operation. Although 5 cases complicated with cerebrospinal fluid leak and all recovered within 1 week, no serious cranium-cerebrum complication occurred. In 29 patients with benign tumor including 11 cases of meningioma, 3 cases of chondroma, 1 case of hemangio-meningioma, 1 case of cavernous hemangioma, 2 cases of osteodysplasia fibromas, 9 cases of neurofibroma, 1 case of glomus jugular tumor, 1 case of neurilemmoma, 19 have survived over 5 years and the longest one has survived over 8 years. For 50 patients with malignant tumor including 3 cases of well-differentiated squamous cell carcinoma, 17 cases of moderately differentiated squamous cell carcinoma, 11 cases of poorly differentiated squamous cell carcinoma, 1 case of undifferentiated carcinoma, 2 cases of chondrosarcoma, 5 cases of canceration of papilloma, 2 cases of adenocarcinoma, 1 case of esthesioneuroblastoma, 2 cases of malignant fibrohistiocytoma, 1 case of fibrosarcoma, 2 cases of malignant mixed tumour, 3 cases of sarcoma survival rates of 3 and 5 years were 59.2% (29/49), 38.5% (10/26) respectively.
In order to resect the tumor completely and reduce the complication and malformation as far as possible, different surgical approaches must be designed according to the pathological changes characters and involved area,and the surgeon should select the shortest approach, avoid to damage the important neurovascular structure, and resect the tumor through the natural anatomy space by the shelter incision.
探讨颅底肿瘤的最佳手术入路。
回顾性分析1992年至2002年山东大学齐鲁医院采用手术切除治疗的79例颅底肿瘤病例。采用包括面中部掀翻术、额冠状切口、鼻外翻、上颌骨摆动、部分上颌骨切除、眶内容全切除术、下颌骨摆动、额颞耳前耳后颈部联合入路及经口入路等11种手术入路切除累及翼腭窝、鼻窦、鼻咽、前中后颅底区域、大脑额叶及颞叶的肿瘤。
79例颅底肿瘤均完全切除，无手术死亡病例。虽有5例出现脑脊液漏，但均在1周内恢复，无严重颅脑并发症发生。29例良性肿瘤患者中，包括脑膜瘤11例、软骨瘤3例、血管母脑膜瘤1例、海绵状血管瘤1例、骨纤维发育不良2例、神经纤维瘤9例、颈静脉球瘤1例、神经鞘瘤1例，19例生存超过5年，最长者生存超过8年。50例恶性肿瘤患者中，包括高分化鳞状细胞癌3例、中分化鳞状细胞癌17例、低分化鳞状细胞癌11例、未分化癌1例、软骨肉瘤2例、乳头状瘤癌变5例、腺癌2例、嗅神经母细胞瘤1例、恶性纤维组织细胞瘤2例、纤维肉瘤1例、恶性混合瘤2例、肉瘤3例，3年和5年生存率分别为59.2%（29/49）、38.5%（10/26）。
为了完整切除肿瘤并尽可能减少并发症和畸形，必须根据病变特点及累及范围设计不同的手术入路，术者应选择最短路径，避免损伤重要神经血管结构，经隐蔽切口通过自然解剖间隙切除肿瘤。
