Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, China.
Chin Med J (Engl). 2010 Feb 5;123(3):281-5.
Surgical management of skull base tumors is still challenging today due to its sophisticated operation procedure. Surgeons who specialize in skull base surgery are making endeavor to promote the outcome of patients with skull base tumor. A reliable skull base reconstruction after tumor resection is of paramount importance in avoiding life-threatening complications, such as cerebrospinal fluid leakage and intracranial infection. This study aimed at investigating the indication, operation approach and operation technique of anterior and middle skull base reconstruction.
A retrospective analysis was carried out on 44 patients who underwent anterior and middle skull base reconstruction in the Department of Neurosurgery at Beijing Tiantan Hospital between March 2005 and March 2008. Different surgical approaches were selected according to the different regions involved by the tumor. Microsurgery was carried out for tumor resection and combined endoscopic surgery was performed in some cases. According to the different locations and sizes of various defects after tumor resection, an individualized skull base soft tissue reconstruction was carried out for each case with artificial materials, pedicled flaps, free autologous tissue, and free vascularized muscle flaps, separately. A skull base bone reconstruction was carried out in some cases simultaneously.
Soft tissue reconstruction was performed in all 44 cases with a fascia lata repair in 9 cases, a free vascularized muscle flap in 1 case, a pedicled muscle flap in 14 cases, and a pedicled periosteal flap in 20 cases. Skull base bone reconstruction was performed on 10 cases simultaneously. The materials for bone reconstruction included titanium mesh, free autogenous bone, and a Medpor implant. The result of skull base reconstruction was satisfactory in all patients. Postoperative early-stage complications occurred in 10 cases with full recovery after conventional treatment.
The specific characteristics of skull base defects in various regions require different reconstruction materials and methods. The individualized reconstruction based on different skull base defects can achieve satisfactory results.
由于手术操作复杂，颅底肿瘤的外科治疗仍然具有挑战性。颅底外科专家正在努力提高颅底肿瘤患者的治疗效果。颅底肿瘤切除后可靠的颅底重建对于避免危及生命的并发症（如脑脊液漏和颅内感染）至关重要。本研究旨在探讨颅前中颅底重建的适应证、手术入路和手术技术。
回顾性分析 2005 年 3 月至 2008 年 3 月在北京天坛医院神经外科行颅前中颅底重建的 44 例患者的临床资料。根据肿瘤累及的不同区域选择不同的手术入路。肿瘤切除采用显微镜手术，部分病例联合内镜手术。根据肿瘤切除后各种缺损的不同位置和大小，采用人工材料、带蒂皮瓣、游离自体组织和游离血管化肌皮瓣分别为每例患者进行个体化颅底软组织重建，部分患者同期行颅底骨重建。
44 例患者均行软组织重建，其中阔筋膜修补 9 例，游离血管化肌皮瓣 1 例，带蒂肌皮瓣 14 例，带蒂骨膜瓣 20 例。同期行颅底骨重建 10 例。骨重建材料包括钛网、游离自体骨和 Medpor 植入物。所有患者颅底重建效果满意。术后早期并发症 10 例，经常规治疗后均完全恢复。
不同区域颅底缺损的特点要求采用不同的重建材料和方法。基于不同颅底缺损的个体化重建可以达到满意的效果。
