Rothweiler R, Metzger M C, Voss P J, Beck J, Schmelzeisen R
Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, Faculty of Medicine, University of Freiburg, Freiburg, 79106 Germany.
J Oral Biol Craniofac Res. 2021 Oct-Dec;11(4):601-607. doi: 10.1016/j.jobcr.2021.09.002. Epub 2021 Sep 11.
Skull base surgery remains one of the challenging areas in the field of cranio-maxillofacial surgery, otolaryngology and neurosurgery. Subsequent reconstruction of bone and soft tissue are an essential component to restore function and appearance after ablative surgery. Establishment of interdisciplinary tumor boards with presentation of the individual patient cases have become standard. Multiplanar reconstruction using MRI or CT imaging techniques combined with virtual 3D planning allow precise planning of the procedures. Intraoperative navigation helps for complete resection of malignant findings with safety margins; surgical approaches provide a good overview of the surgical site. Reconstruction using local flaps have a low complication rate with equally reliable results in reconstruction of small tissue defects. Free flap surgery makes reconstruction of large tissue defects possible. Alloplastic materials are alternatively used for reconstruction of bone defects. Based on selected patients, treatment algorithms and standard surgical procedures in extracerebral skull base surgery will be illustrated. Current techniques and new approaches will be discussed with emphasize on hard and soft tissue reconstruction.
颅底手术仍然是颅颌面外科、耳鼻喉科和神经外科领域中具有挑战性的领域之一。骨和软组织的后续重建是消融手术后恢复功能和外观的重要组成部分。建立跨学科肿瘤委员会并展示个体病例已成为标准做法。使用MRI或CT成像技术结合虚拟3D规划进行多平面重建可实现手术的精确规划。术中导航有助于安全切缘完整切除恶性病变；手术入路能很好地显示手术部位。使用局部皮瓣进行重建并发症发生率低，在修复小组织缺损方面效果同样可靠。游离皮瓣手术使大组织缺损的修复成为可能。异体材料可用于骨缺损的修复。将基于选定的患者说明脑外颅底手术的治疗算法和标准手术程序。将讨论当前技术和新方法，重点是硬组织和软组织重建。
