Nakamura M, Stöver T, Rodt T, Majdani O, Lorenz M, Lenarz T, Krauss J K
Department of Neurosurgery, Medical University Hannover, Hannover, Germany.
Eur J Surg Oncol. 2009 Jun;35(6):666-72. doi: 10.1016/j.ejso.2008.10.011. Epub 2008 Dec 3.
Due to the destruction of osseous landmarks of the skull base or paranasal sinuses, the anatomical orientation during surgery of frontobasal or clival tumors with (para)nasal extension is often challenging. In this relation computer assisted surgical (CAS) guidance might be a useful tool. Here, we explored the use of CAS in an interdisciplinary setting.
The surgical series consists of 13 patients who underwent a lateral rhinotomy combined with a subfrontal craniotomy in case of significant intracranial tumor extension. The procedures were planned and assisted by advanced CAS techniques with image fusion of CT and MRI. Tumors included carcinomas (one case associated with an olfactory groove meningioma), esthesioneuroblastoma, chordoma, chondrosarcoma and ganglioglioma.
The application of CAS in the combined approaches was both safe and reliable for delineation of tumors and identification of vital structures hidden or encased by the tumors. There was no perioperative 30-day mortality; however two patients died 5 weeks and 5 months after craniofacial tumor resection due to worsening medical conditions. The most common perioperative morbidity was postoperative wound complication in two cases. Tumors were either removed completely, or subtotal resection was achieved allowing targeted postoperative radiotherapy.
Craniofacial approaches with intraoperative neuronavigational guidance in a multidisciplinary setting allow safe resection of large tumors of the upper clivus and the paranasal sinuses involving the anterior skull base. Complex skull base surgery with the involvement of bony structures appears to be an ideal field for advanced navigation techniques given the lack of intraoperative shift of relevant structures.
由于颅底或鼻窦骨性标志的破坏，额底或斜坡肿瘤伴（副）鼻窦侵犯手术时的解剖定位常常具有挑战性。在这种情况下，计算机辅助手术（CAS）引导可能是一种有用的工具。在此，我们探讨了CAS在多学科环境中的应用。
该手术系列包括13例患者，若肿瘤有显著颅内侵犯，则行外侧鼻切开术联合额下入路开颅手术。手术通过先进的CAS技术进行规划和辅助，将CT和MRI图像融合。肿瘤包括癌（1例合并嗅沟脑膜瘤）、嗅神经母细胞瘤、脊索瘤、软骨肉瘤和节细胞胶质瘤。
CAS在联合手术入路中的应用对于肿瘤的勾勒以及识别被肿瘤隐藏或包裹的重要结构既安全又可靠。围手术期30天内无死亡病例；然而，两名患者在颅面肿瘤切除术后5周和5个月因病情恶化死亡。最常见的围手术期并发症是两例术后伤口并发症。肿瘤要么被完全切除，要么实现次全切除，以便进行有针对性的术后放疗。
在多学科环境中采用术中神经导航引导的颅面入路可安全切除累及前颅底的上斜坡和鼻窦的大型肿瘤。鉴于相关结构术中无移位，涉及骨性结构的复杂颅底手术似乎是先进导航技术的理想应用领域。
