Sekhar L N, Nanda A, Sen C N, Snyderman C N, Janecka I P
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
J Neurosurg. 1992 Feb;76(2):198-206. doi: 10.3171/jns.1992.76.2.0198.
The extended frontal approach is a modification of the transbasal approach of Derome. The addition of a bilateral orbitofrontal or orbitofrontoethmoidal osteotomy improves the exposure of midline lesions of the anterior, middle, and posterior skull base, while minimizing the need for frontal lobe retraction. The authors present a 5-year experience with 49 patients operated on via the extended frontal approach. In seven patients, the extended frontal approach was used alone; in the remaining 42, it was combined with other skull base approaches. Highly malignant tumors were removed en bloc, whereas benign tumors and low-grade malignancies were removed either en bloc or piecemeal. Reconstruction was usually performed using fascia lata, a pericranial flap, and/or autologous fat. A temporalis muscle flap or a distant microvascular free flap was required for some patients. One patient died 1 month postoperatively due to superior mesenteric artery thrombosis. Three patients had postoperative infections, two had cerebrospinal fluid leaks requiring reoperation, and four had brain contusions or hematomas. All but two patients recovered to their preoperative functional level. After an average follow-up period of 26 months (range 6 to 56 months), 64% of patients with benign lesions, 64% of patients with low-grade malignancies, and 44% of patients with high-grade lesions were alive with no evidence of disease.
扩大额部入路是对德罗姆经颅底入路的一种改良。增加双侧眶额或眶额筛骨截骨术可改善前、中、后颅底中线病变的显露，同时尽量减少额叶牵拉的必要性。作者介绍了49例采用扩大额部入路手术患者的5年经验。7例患者单独使用扩大额部入路；其余42例则与其他颅底入路联合使用。高度恶性肿瘤整块切除，而良性肿瘤和低度恶性肿瘤则整块或分块切除。重建通常使用阔筋膜、颅骨膜瓣和/或自体脂肪。部分患者需要颞肌瓣或远处微血管游离瓣。1例患者术后1个月因肠系膜上动脉血栓形成死亡。3例患者发生术后感染，2例脑脊液漏需要再次手术，4例发生脑挫伤或血肿。除2例患者外，所有患者均恢复到术前功能水平。平均随访26个月（6至56个月）后，64%的良性病变患者、64%的低度恶性病变患者和44%的高度病变患者存活，无疾病证据。
