Department of Neurosurgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
World Neurosurg. 2021 Aug;152:e62-e70. doi: 10.1016/j.wneu.2021.04.084. Epub 2021 Apr 30.
Surgical treatment of advanced intracranial and extracranial communicating skull base tumors is challenging, especially for the reconstruction of the large composite defect left by tumor resection. The aim of the study is to evaluate the utility of the free flap reconstruction of the defects resulting from radical resection of these tumors in a single institution.
The clinical data of 17 consecutive patients who underwent free flap reconstruction for defect left by salvage resection of advanced intracranial and extracranial communicating tumors from 2013 to 2019 were retrospectively collected and analyzed.
There were 5 squamous cell carcinomas, 4 adenoid cystic carcinomas, 2 basal cell carcinomas, 2 meningiomas, 1 anaplastic hemangiopericytoma, 1 pleomorphic adenoma, 1 osteosarcoma, and 1 chondrosarcoma. All patients had recurrent neoplasms, 2 of whom had pulmonary metastasis. A modified radical cervical dissection was performed in 6 patients. The anterolateral thigh myocutaneous flap and rectus abdominis myocutaneous flap were used in 15 patients (88.2%) and 2 patients (11.8%), respectively. Complications were seen in 3 of 17 patients (17.6%) with 1 total flap loss. The median progression-free survival duration was 31 months. The 3- and 5-year progression-free survival rates were 0.47 and 0.24, respectively. The mean overall survival duration was 66 months. The 3- and 5-year overall survival rates were 0.85 and 0.68, respectively.
Free flap transfer is a safe and effective method with acceptable complications, useful for reconstruction of large composite skull base defects after salvage resection of advanced intracranial and extracranial communicating tumors. The functional and cosmetic results are satisfying.
颅内外沟通性颅底肿瘤的晚期手术治疗极具挑战性，尤其是对于肿瘤切除后留下的大型复合缺损的重建。本研究旨在评估在一家机构中使用游离皮瓣重建这些肿瘤根治性切除后遗留的缺损的效果。
回顾性收集并分析了 2013 年至 2019 年期间，17 例连续接受游离皮瓣重建挽救性切除颅内外沟通性晚期肿瘤后遗留缺损的患者的临床资料。
患者中包括 5 例鳞状细胞癌、4 例腺样囊性癌、2 例基底细胞癌、2 例脑膜瘤、1 例间变性血管外皮细胞瘤、1 例多形性腺瘤、1 例骨肉瘤和 1 例软骨肉瘤。所有患者均为复发性肿瘤，其中 2 例有肺转移。6 例患者行改良根治性颈淋巴结清扫术。15 例患者（88.2%）使用了股前外侧肌皮瓣，2 例患者（11.8%）使用了腹直肌肌皮瓣。17 例患者中有 3 例（17.6%）出现并发症，1 例出现全层皮瓣坏死。无进展生存期的中位数为 31 个月。3 年和 5 年无进展生存率分别为 0.47 和 0.24。总生存期的平均值为 66 个月。3 年和 5 年总生存率分别为 0.85 和 0.68。
游离皮瓣移植是一种安全有效的方法，并发症可接受，对于挽救性切除颅内外沟通性晚期肿瘤后大型复合颅底缺损的重建具有重要意义。功能和美容效果令人满意。
