Zubillaga-Rodríguez I, Falguera-Uceda M I, Sánchez-Aniceto G, Montalvo-Moreno J J, Díez-Lobato R
Servicios de Cirugía Oral y Maxilofacial y de Neurocirugía Hospital Universitario 12 de Octubre. Madrid, Spain.
Neurocirugia (Astur). 2010 Dec;21(6):467-77.
INTRODUCTION. Suitable approach to anterior cranial base is mandatory to get global satisfactory surgical outcomes. In the beginning it depends on the exactly anatomical position into the cranial fossa and tridimensional spread. Surgical approach implies the evaluation of the patient status, reconstructive options and surgical team experience. Subcranial approach is a safe surgical option in the treatment of frontal traumatic pathology. It allows adequate management of frontal sinus and its obliteration with easy radiologic follow-up. OBJECTIVES. To analyse subcranial approach as a treatment option in traumatic pathology of the anterior cranial base and to present our review of subcranial approach. Valuation of surgical technical aspects. and related complications. MATERIAL AND METHODS. Retrospective analysis of 50 patients operated (subcranial approach) from January 2004 to December 2009 by Maxillofacial and Neurosurgery Department, University Hospital 12 de Octubre, Madrid. 34 patients presented craniofacial trauma or postraumatic sequela and 16 patients presented craniofacial tumours. Oncological cases offers experience to discuss surgical aspects. Results are related to traumatic pathology and sequela. Main items review were surgical technique including materials used for frontal sinus obliteration, associated traumatic pathology, hospital stay and complication rates. RESULTS. No perioperatory mortality was found. Patients´ age ranged 15-76 years. 22 were male and 12 female. Description of frontal fractures involved. Frontal sinus obliteration was made with calvarian bone dust. Morbidity rates was 29% in posttraumatic patients. Mean hospital stay was 13 days.
Subcranial approach to anterior cranial base is a safe and reliable treatment option to the pathology of this area. It allows outstanding exposure of the nasal cavity, orbits, ethmoidal cells-sphenoid sinus and great access to anterior fossa without frontal lobe retraction.
引言。要获得整体满意的手术效果，采用合适的前颅底入路至关重要。起初，这取决于在颅窝内的确切解剖位置及三维扩展情况。手术入路意味着要评估患者状况、重建方案以及手术团队的经验。颅下入路是治疗额部创伤性病变的一种安全手术选择。它能对额窦进行充分处理并将其闭塞，且便于影像学随访。目的。分析颅下入路作为前颅底创伤性病变的一种治疗选择，并展示我们对颅下入路的综述。评估手术技术方面及相关并发症。材料与方法。对2004年1月至2009年12月在马德里12月10日大学医院颌面外科和神经外科接受手术（颅下入路）的50例患者进行回顾性分析。34例患者有颅面创伤或创伤后后遗症，16例患者有颅面肿瘤。肿瘤病例为讨论手术方面提供了经验。结果与创伤性病变及后遗症相关。主要回顾项目包括手术技术，包括用于额窦闭塞的材料、相关创伤性病变、住院时间和并发症发生率。结果。未发现围手术期死亡病例。患者年龄在15 - 76岁之间。男性22例，女性12例。描述了所涉及的额骨骨折情况。用颅骨骨屑进行额窦闭塞。创伤后患者的发病率为29%。平均住院时间为13天。
前颅底的颅下入路是该区域病变的一种安全可靠的治疗选择。它能出色地暴露鼻腔、眼眶、筛窦 - 蝶窦，且无需牵拉额叶就能很好地进入前颅窝。
