“三明治”法重建颅底技术的探讨

目的探讨颅前窝底肿瘤切除后颅底重建技术。方法回顾性分析6例颅前窝底肿瘤的临床资料．复发颅咽管瘤2例，复发嗅沟脑膜瘤2例，筛窦低分化腺癌1例，嗅神经母细胞瘤1例。手术采用扩大双额、双骨瓣开颅．肿瘤切除后，颅前窝底骨质缺损直径5．0-7．0cm，颅前窝底硬膜缺损直径约6．0～9．0cm。采用“三明治”法重建颅底，硬膜缺损以游离自体骨膜或颞肌筋膜修补，额部带蒂骨膜覆盖于鼻根部小骨瓣并与颅底硬膜缝合，两者之间用钛板修补骨性缺损。结果肿瘤完全切除6例。术后无一例出现脑脊液鼻漏。术后颅内感染1例，经抗感染治疗及腰大池脑脊液持续引流后治愈。结论“三明治”法重建颅底可获得优良效果。颅前窝底肿瘤彻底切除后可获得良好的长期预后。

Exploration of sandwich technique for skull base reconstruction

Objective To explore the skull base reconstruction techniques after the removal of anterior skull base tumor. Methods Clinical data of 6 patients with the skull base reconstruction were analyzed retrospectively. There were 2 cases of recurrent craniopharyngioma, 2 of recurrent olfactory groove meningioma, 1 low differentiated adenocarcinoma of the ethmoid sinus and 1 olfactory neuroblastoma. All the 6 received extended bilateral frontal craniotomy. The anterior skull base defect after removal of the tumors was 5.0-7.0 cm in diameter, and the dura defect was 6.0-9.0 cm in diameter. The anterior skull base was reconstructed by sandwich technique： vascularized pericranium which covered the small bone flap, and free pericranium or temporalis fascia patch repairing the skull base dural defect with the titanium mesh in the middle. Results Total removal of the tumor was achieved in all the 6 patients. None of 6 patients had cerebral spinal fluid rhinorrhea after surgery. One patient had intraeranial infection after surgery, which was cured by antibiotics and lumber cistern drainage. Conclusions Sandwich technique is an excellent option for reconstruction of the anterior skull base defect. A good long term prognosis can be expected after radical removal of the anterior skull base tumor.