Janecka I P, Sen C N, Sekhar L N, Nuss D W
Department of Otolaryngology and Neurological Surgery, University of Pittsburgh, School of Medicine PA 15213.
Keio J Med. 1991 Dec;40(4):215-20. doi: 10.2302/kjm.40.215.
The complexity of cranial base surgery is a reflection of skull base anatomy as well as technical demands for maximum visualization, control of essential structures, adequate tumor resection and/or reconstruction. Facial translocation has been developed as a new approach to cranial base. It consists of extensive modular facial disassembly which includes displacement of composite facial soft tissue flap and craniofacial skeleton. It creates surgical field with epicenter in nasopharynx and infratemporal fossa allowing easy expansion into sphenoid bone and cranial fossae as well as craniovertebral junction. Reconstruction is functional and esthetic. Versatility of this approach permits expansion into neighboring craniofacial regions. During a 14-month period (11/88-12/89), this facial translocation approach to cranial base was utilized in 20 patients. The approach provided excellent visualization of the involved cranial base permitting oncological as well as reconstructive procedures. All patients healed primarily. Two patients were reoperated on at 4 and 6 months postoperatively; one for a bone graft infection and the other for tumor recurrence. The facial translocation approach offers favorable exposure of the critical zones of cranial base resulting in increased surgical safety and benefit of cranial base surgery.
颅底手术的复杂性反映了颅底的解剖结构以及对最大程度可视化、控制重要结构、充分切除肿瘤和/或进行重建的技术要求。面部移位术已发展成为一种治疗颅底疾病的新方法。它包括广泛的模块化面部拆解，其中包括复合面部软组织瓣和颅面骨骼的移位。它在鼻咽部和颞下窝形成了以其为中心的手术视野，便于轻松扩展至蝶骨、颅窝以及颅颈交界区。重建既具有功能性又具有美观性。这种方法的多功能性允许扩展至相邻的颅面区域。在14个月的时间里（1988年11月至1989年12月），20例患者采用了这种面部移位术治疗颅底疾病。该方法能够很好地显露受累的颅底，从而允许进行肿瘤切除及重建手术。所有患者一期愈合。两名患者分别在术后4个月和6个月接受了再次手术，一名是因为骨移植感染，另一名是因为肿瘤复发。面部移位术能够很好地显露颅底的关键区域，从而提高了颅底手术的安全性并增加了手术收益。
