Donald P J
Department of Otolaryngology-Head & Neck Surgery, University of California, Davis.
Minim Invasive Neurosurg. 1994 Dec;37(2):37-41. doi: 10.1055/s-2008-1053446.
The potential for remediation of a host of varied disease processes afflicting the skull base has been increasingly realized over the past two decades. Advances in medical technology, the development of new approaches, and most importantly the close cooperation of the head and neck surgeon and the neurological surgeon have made this possible. Surgeons are attempting to diminish the injury to normal un-involved structures while at the same time maximizing exposure and enabling rectification of the disease or disorder. This is especially pertinent in a number of frontobasal approaches used in anterior craniofacial surgery. The osteoplastic flap approach to the posterior wall of the frontal sinus to repair small cerebrospinal fluid leaks and manage posterior wall fractures saves the patient a larger anterior craniotomy and brain retraction. Cranialization of the frontal sinus in comminuted through-and-through fractures allows for removal of devitalized brain, dural repair, and safe management of the frontal sinus. The lateral rhinotomy medial maxillectomy-ethmosphenoidectomy approach coupled with either an osteoplastic flap of the frontal sinus or a low limited craniotomy is an excellent approach for resection of tumors encroaching on the anterior skull base. Even malignancies of this region can be completely excised with adequate margins, yet produce minimal to no facial aesthetic distortion. Moreover, larger tumors requiring a more extensive lip-splitting incision and total maxillectomy with orbital exenteration can often anticipate minimal deformity, especially with good prosthetic rehabilitation. In the resection of aggressive malignancies, techniques of ocular preservation and facial bone sparing have been developed with encouraging cosmetic results.
在过去二十年里，人们越来越意识到对一系列影响颅底的各种疾病过程进行修复的可能性。医学技术的进步、新方法的发展，以及最重要的是头颈外科医生和神经外科医生的密切合作，使这成为可能。外科医生试图减少对正常未受累结构的损伤，同时最大限度地扩大暴露范围，并对疾病或病症进行矫正。这在一些用于前颅面手术的额底入路中尤为重要。采用骨成形瓣入路处理额窦后壁以修复小的脑脊液漏和处理后壁骨折，可为患者避免更大的前开颅手术和脑牵拉。对于粉碎性贯通骨折的额窦进行颅骨化处理，可清除失活的脑组织、进行硬脑膜修复，并安全处理额窦。外侧鼻切开术联合内侧上颌骨切除术 - 筛蝶窦切除术，再结合额窦骨成形瓣或低位有限开颅术，是切除侵犯前颅底肿瘤的极佳方法。即使是该区域的恶性肿瘤，也可以在有足够切缘的情况下完全切除，且对面部美观的影响极小或没有影响。此外，对于需要更广泛唇裂切口和全上颌骨切除并眶内容物剜出术的较大肿瘤，通常可以预期畸形最小，特别是在良好的假体修复情况下。在侵袭性恶性肿瘤的切除中，已经开发出了保留眼球和保留面骨的技术，取得了令人鼓舞的美容效果。
