Singh Amit Kumar, Srivastava Arun Kumar, Sardhara Jayesh, Bhaisora Kamlesh Singh, Das Kuntal Kanti, Mehrotra Anant, Sahu Rabi Narayan, Jaiswal Awadhesh Kumar, Behari Sanjay
Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India.
Asian J Neurosurg. 2017 Jul-Sep;12(3):506-513. doi: 10.4103/1793-5482.185068.
Skull base lesions are not uncommon, but their management has been challenging for surgeons. There is large no of bony tumors at the skull base which has not been studied in detail as a group. These tumors are difficult not only because of their location but also due to their variability in the involvement of important local structure. Through this retrospective analysis from a Tertiary Care Centre, we are summarizing the details of skull base bony lesions and its management nuances.
The histopathologically, radiologically, and surgically proven cases of skull base bony tumors or lesions involving bone were analyzed from the neurosurgery, neuropathology record of our Tertiary Care Institute from January 2009 to January 2014. All available preoperative and postoperative details were noted from their case files. The extent of excision was ascertained from operation records and postoperative magnetic resonance imaging if available.
We have surgically managed 41 cases of skull base bony tumors. It includes 11 patients of anterior skull base, 13 middle skull base, and 17 posterior skull base bony tumors. The most common bony tumor was chordoma 15 (36.6%), followed by fibrous dysplasia 5 (12.2%), chondrosarcoma (12.2%), and ewings sarcoma-peripheral primitive neuroectodermal tumor (EWS-pPNET) five cases (12.2%) each. There were more malignant lesions ( = 29, 70.7%) at skull base than benign ( = 12, 29.3%) lesions. The surgical approach employed depended on location of tumor and pathology. Total mortality was 8 (20%) of whom 5 patients were of histological proven EWS-pPNET.
Bony skull base lesion consists of wide variety of lesions, and requires multispecialty management. The complex lesions required tailored approaches surgery of these lesions. With the advent of microsurgical and endoscopic techniques, and use of navigation better outcomes are being seen, but these lesions require further study for development of proper management plan.
颅底病变并不罕见，但对外科医生来说，其治疗一直具有挑战性。颅底有大量的骨肿瘤，作为一个整体尚未得到详细研究。这些肿瘤之所以棘手，不仅是因为其位置，还因其累及重要局部结构的情况存在差异。通过对一家三级医疗中心的回顾性分析，我们总结了颅底骨病变的详细情况及其治疗要点。
对2009年1月至2014年1月期间在我们三级医疗研究所神经外科、神经病理学记录中经组织病理学、放射学和手术证实的累及骨骼的颅底骨肿瘤或病变病例进行分析。从他们的病历中记录所有可用的术前和术后详细信息。如果有术后磁共振成像，从手术记录和术后磁共振成像确定切除范围。
我们手术治疗了41例颅底骨肿瘤。其中包括11例前颅底、13例中颅底和17例后颅底骨肿瘤。最常见的骨肿瘤是脊索瘤15例（36.6%），其次是骨纤维发育不良5例（12.2%）、软骨肉瘤（12.2%）以及尤因肉瘤-外周原始神经外胚层肿瘤（EWS-pPNET）各5例（12.2%）。颅底的恶性病变（n = 29，70.7%）比良性病变（n = 12，29.3%）更多。所采用的手术入路取决于肿瘤的位置和病理类型。总死亡率为8例（20%），其中5例经组织学证实为EWS-pPNET。
颅底骨病变包括多种类型的病变，需要多学科管理。复杂病变需要针对这些病变的定制手术方法。随着显微外科和内镜技术的出现以及导航的使用，正在看到更好的治疗效果，但这些病变需要进一步研究以制定合适的管理计划。
