Fukuta K, Saito K, Takahashi M, Torii S
Department of Plastic Surgery, Komaki City Hospital, Japan.
Plast Reconstr Surg. 1997 Aug;100(2):318-25. doi: 10.1097/00006534-199708000-00006.
Through the frontal approach, a skull base tumor in the deep midline region is obscured by the cribriform plate. This paper demonstrates our experience of operating on seven patients with midline skull base tumors posterior to the cribriform plate using a technique of maintaining the olfactory-cribriform anatomy. Following a bifrontal craniotomy and an orbitonaso-glabellar osteotomy, a circumferential osteotomy of the cribriform plate and horizontal incision of the nasal mucosa permitted mobilization of the cribriform plate unit along with the frontal lobe, providing a wide exposure of the posterior midline area. Tumors were resected from the posterior nasopharynx, ethmoid sinus, sphenoid sinus, and upper portion of the clivus. The skull base defects were repaired with the bipedicled temporoparietal galeal flap. Two patients lost olfaction because of poor preservation of the nasal mucosa and intradural dissection of the olfactory bulb. Five patients showed complete recovery of olfaction in 8 weeks. None of the patients developed cerebrospinal fluid leakage, infection, or increased neurologic deficits. En bloc mobilization of the cribriform plate and the bipedicled temporoparietal galeal flap are very useful for the management of midline cranial base tumors posterior to the cribriform plate as long as the olfactory unit is not involved with tumors.
通过额部入路，位于深部中线区域的颅底肿瘤会被筛板遮挡。本文展示了我们运用保留嗅-筛板解剖结构的技术，对7例筛板后方中线颅底肿瘤患者进行手术的经验。在双侧额部开颅及眶鼻-眉间截骨术后，对筛板进行环形截骨并水平切开鼻黏膜，可使筛板单元与额叶一起活动，从而广泛暴露后方中线区域。肿瘤从鼻咽后部、筛窦、蝶窦和斜坡上部切除。颅底缺损用双蒂颞顶部帽状腱膜瓣修复。2例患者因鼻黏膜保留不佳及嗅球硬膜内解剖而丧失嗅觉。5例患者在8周内嗅觉完全恢复。所有患者均未发生脑脊液漏、感染或神经功能缺损加重。只要嗅单元未被肿瘤累及，筛板的整块活动及双蒂颞顶部帽状腱膜瓣对处理筛板后方的中线颅底肿瘤非常有用。
