Donald P J
Department of Otolaryngology/Head & Neck Surgery, University of California, Davis.
Aust N Z J Surg. 1989 Jul;59(7):523-8. doi: 10.1111/j.1445-2197.1989.tb01624.x.
Craniofacial surgery has revolutionized the management of extensive malignancies and histologically benign but locally invasive tumours which encroach upon or directly invade the undersurface of the brain case. Approaches have been devised for tumours that involve the anterior middle and posterior fossae. Teamwork between head and neck and neurological surgeons is essential. Comprehensive pre-operative evaluation, especially the adequacy of cross-fill of the cerebral circulation via the contralateral arterial system through the circle of Willis, must be done. Management of the internal carotid artery and cavernous sinus presents the most difficult surgical problems during the resection. During the closure, separation of the intracranial dissection from the paranasal sinuses and epipharynx by the use of flaps and grafts is essential to prevent cerebrospinal fluid leakage, cerebral support, and isolation of the carotid and dura from upper respiratory tract organisms. Well-planned and executed craniofacial surgery can be done with acceptable morbidity and mortality rates and reasonable survival rates.
颅面外科手术彻底改变了对广泛恶性肿瘤以及组织学上为良性但局部侵袭性肿瘤的治疗方式，这些肿瘤侵犯或直接侵入颅底。针对累及前、中、后颅窝的肿瘤，已经设计出了多种手术入路。头颈外科医生和神经外科医生之间的团队合作至关重要。必须进行全面的术前评估，尤其是通过 Willis 环对侧动脉系统对脑循环交叉充盈的充分性评估。在切除过程中，颈内动脉和海绵窦的处理是最困难的手术问题。在关闭创口时，使用皮瓣和移植物将颅内手术区域与鼻窦和咽上部隔开，对于防止脑脊液漏、提供脑支持以及将颈动脉和硬脑膜与上呼吸道微生物隔离至关重要。精心规划和实施的颅面外科手术可以在可接受的发病率和死亡率以及合理的生存率情况下完成。
