Beals S P, Joganic E F, Holcombe T C, Spetzler R F
Southwest Craniofacial Center, Phoenix, Arizona, USA.
Clin Plast Surg. 1997 Jul;24(3):565-81.
Skull base wounds remain the most challenging that a skull base surgeon faces because of the unique and unforgiving requirements of the intracranial compartment. To successfully reconstruct these defects after complex exposure and radical resection around vital structures, a most conservative approach must be taken (i.e., one must choose the option that has the greatest chance to be successful, even if it means taking the extra time and effort of doing a free tissue transfer). Indeed, one can take no short cuts if the skull base would be left with a tenuous repair. Close postoperative surveillance of the patient for complications and maximal medical management is essential. Because of the difficulty of examining the hidden skull base wound postoperatively, surgeons must have a low threshold for re-exploration if a complication is suspected. As the first decade of the multidisciplinary skull base team approach passes, and long-term results are being assessed, the question of "is it worth it?" is fair. The reported series are showing increased survival rates and decreased complication rates. Therefore, the answer would appear to be "yes". The question is best answered, however, by the individual patient who previously had no hope for treatment of his or her deep-seated skull base tumor.
颅底创伤仍然是颅底外科医生面临的最具挑战性的问题，因为颅内腔室有独特且苛刻的要求。为了在对重要结构进行复杂暴露和根治性切除后成功修复这些缺损，必须采取最保守的方法（即必须选择最有可能成功的方案，即使这意味着要花费额外的时间和精力进行游离组织移植）。事实上，如果颅底修复不稳固，就不能走捷径。术后密切监测患者有无并发症并进行最大程度的药物治疗至关重要。由于术后检查隐蔽的颅底伤口存在困难，如果怀疑有并发症，外科医生必须有较低的再次探查门槛。随着多学科颅底团队方法进入第一个十年并对长期结果进行评估，“这值得吗？”这个问题是合理的。报告的系列病例显示生存率提高且并发症率降低。因此，答案似乎是“值得”。然而，对于之前对其深部颅底肿瘤治疗不抱希望的个体患者来说，这个问题的最佳答案才最有说服力。
