Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University.
Department of Neurosurgery, Huishan Peoples Hospital, Wuxi.
J Craniofac Surg. 2021;32(5):1673-1678. doi: 10.1097/SCS.0000000000007244.
Anterior cranial fossa intra- and extracranial tumors arise from the anterior cranial fossa and invade the orbit and nose. Anterior cranial fossa tumor resection and skull base reconstruction are challenging for neurosurgeons due to the complex anatomy, leakage of cerebrospinal fluid, and critical neurovasculature involvement. The authors report a case series of cranio-orbital communicating tumors and cranionasal-orbital communicating tumors. All patients underwent a modified Derome approach or transfrontal basal approach, and all tumor resections were satisfactory. Skull base reconstruction for small defects (<1.5 cm) can be performed with autogenous fascia, muscle, and fat. Large defects (≥1.5 cm) require autogenous fascia, muscle, and fat combined with osseous reconstruction (autogenous bone, titanium mesh, and polyetheretherketone). The techniques and treatments were successful, and only 1 patient experienced mild cerebrospinal fluid leak but no intracranial infection, pneumocrania or intracranial hemorrhage. Additionally, long-term follow-up demonstrated that the outcomes remain favorable. According to a literature review, this technique might be an alternative strategy for treating anterior cranial fossa intra- and extracranial tumors, and better skull base reconstruction can prevent many postoperative complications.
颅前窝颅内和颅外肿瘤起源于颅前窝，并侵犯眼眶和鼻腔。由于复杂的解剖结构、脑脊液漏和关键的神经血管受累，颅前窝肿瘤切除术和颅底重建对神经外科医生来说极具挑战性。作者报告了一系列颅眶沟通性肿瘤和颅鼻眶沟通性肿瘤的病例。所有患者均采用改良的 Derome 入路或经额基底入路，所有肿瘤均切除满意。对于<1.5cm 的小缺损，可采用自体筋膜、肌肉和脂肪进行颅底重建。对于≥1.5cm 的大缺损，需要自体筋膜、肌肉和脂肪联合骨重建（自体骨、钛网和聚醚醚酮）。这些技术和治疗方法均取得了成功，仅有 1 例患者出现轻微的脑脊液漏，但无颅内感染、气颅或颅内出血。此外，长期随访显示，治疗效果仍然良好。根据文献复习，该技术可能是治疗颅前窝颅内和颅外肿瘤的一种替代策略，更好的颅底重建可以预防许多术后并发症。
