额眶筛入路切除前中颅底颅鼻眶沟通瘤

目的探讨切除前中颅底、额、筛窦、眶沟通性肿瘤的最佳手术方式,以满足临床需要。方法对13例前中颅底颅鼻眶沟通瘤患者采用额眶筛入路、T型切口,将外鼻下翻,切除部分筛窦、纸板、额骨眶部及额窦后壁,充分暴露肿瘤组织,在手术显微镜下分块或完全切除肿瘤,分离、保护相应解剖部位,如视神经、内动脉、蝶鞍和脑膜等重要解剖结构。将外鼻回复,用钛板钛钉与额骨固定,恢复良好颌面外形。结果13例颅鼻眶沟通瘤手术均获得成功,随访24个月,11例肿瘤无复发,均无脑脊液鼻漏、脑膜脑膨出等并发症。面部外形良好。结论经额眶筛进入、侧下翻鼻骨入路是耳鼻咽喉科切除前中颅底颅鼻眶沟通瘤的一种良好方法。

Resection of tumors involving the cranio-naso-orbital area via fronto-orbito-ethmoidal approach

OBJECTIVE: To introduce a better surgical approach for the resection of tumors involving the anterior and middle skull base and the fronto-orbito-ethmoidal area. METHODS: A "T" form incision was made in the fronto-orbito-ethmoidal region and along the nasal pyramid down. Parts of ethmoid sinus, lamina papyracea, fronto-orbito bone and behind wall of frontal sinus were resected in order to expose the tumors in the anterior skull base and the fronto-orbito-ethmoidal region. Then, the tumor was resected partly under the operation microscope, protecting the neighbouring important structures, for instance: optic nerve, internal carotid artery, sella, meninx, etc. The nasal pyramid was repaired and fixed to the frontal bone with titanium board and titanium nail in order to resume the appearance of a good face. RESULTS: Thirteen patients received tumour resection through this approach. The patients were followed-up for 24 months, 11 patients showed no tumour recurrence, no severe complication, such as cerebrospinal rhinorrhea, meningoencephlocele, etc, in this series. The facial appearance was good. CONCLUSIONS: The approach via the fronto-orbito-ethmoidal region is a good surgical procedure to resect the tumors involving the anterior and middle skull base and the fronto-orbito-ethmoidal area.