Central skull base invasion of maxillofacial tumors: computed tomography appearance

OBJECTIVE: The aim of this study was to demonstrate computed tomography (CT) features of maxillofacial tumors invading the central skull base and to offer information in aiding diagnosis. METHODS: Fifty-eight maxillofacial tumors with central skull base invasion shown on axial and coronal CT images were divided into benign (13 cases) and malignant (45 cases) groups, based on their pathologic outcomes as proven by biopsy and surgery. RESULTS: Four manifestations of the skull base abnormality were observed on CT images: (1) resorption of central skull base (53 cases, 11 benign and 42 malignant tumors); (2) enlargement of the foramen and canal in the central skull base (20 cases, 4 benign and 16 malignant tumors); (3) thinning of the central skull base (11 cases, 8 benign and 3 malignant tumors); and (4) displacement of the central skull base (5 cases, all benign tumors). The following structures of the central skull base were involved: the roof of the pterygoid process of the sphenoid bone (49 cases), the sphenoid greater wing (37 cases), the sphenoid body and sinus (33 cases), the petrous apex (12 cases), the clivus (4 cases), and the articular surface of the temporal squama (3 cases). Of 58 patients, 30 (7 benign and 23 malignant) had tumors with central skull base erosion that infiltrated into the cranial cavity. CONCLUSION: Benign maxillofacial tumors with center skull base erosion tended to lead to the displacement and thinning of the base of the middle skull fossa in contrast with tumors with malignant maxillofacial tumors. It is believed that these CT manifestations might be valuable in making a differential diagnosis.     

口腔颌面部复发性肿瘤破坏中颅底的CT表现

目的显示口腔颌面部复发性肿瘤侵犯中颅底的ＣＴ表现。方法３７例口腔颌面部复发性肿瘤患者被行以横轴面和冠状面（２６例）ＣＴ检查,所有病变均经病理检查证实。结果ＣＴ上显示的中颅底破坏方式有四种：（１）颅底骨外板吸收（５例）;（２）颅底骨内外板均吸收（２４例）;（３）卵圆孔扩大（３例）;（４）颅底骨硬化和吸收并存（５例）。复发性肿瘤破坏中颅底最多的结构是蝶骨大翼（３６例）。ＣＴ显示病变侵入颅内者共２４例,受累的颅内结构有海绵窦（１６侧）,大脑颞叶（１５侧）和脑垂体（１例）。结论ＣＴ上显示的颅内侵犯与上述中颅底破坏方式密切相关。ＣＴ检查有助于临床上评价颌面复发性肿瘤侵犯中颅底。     

颅外原发性病变破坏颅中窝底的CT表现

目的 评价颅外原发性病颅中窝底的ＣＴ表现特点。方法 将４９例经病理证实的破坏颅中底的颅外的发病变分为两组;颅中窝底原发骨性病变;１０例;颌面部原发病变;３９例。结果 颅外病变破坏颅中窝底的方式有４种;（１）骨吸收（３０例）,包括１６例颅中窝底外板吸收和１４例内外板均吸收;（２）颅中窝底硬化增厚（４例）;（３）圆孔和卵圆孔扩大（９例）;（４）硬化和吸收并存（６例）。受累的颅内结构：海绵窦１２例,颞叶     

颅底三维CT在颅颌外科中的应用价值

目的　评价三维CT在颅颌外科中的应用价值。方法　口腔颌面部肿瘤可疑侵及颅底患者54例,治疗前行CT检查,用表面阴影成像法进行重建,后与术中所见对照分析,总结其应用的经验及局限性。结果　证实有颅底破坏者24例,颅底三维CT能很好地反映口腔颌面部肿瘤是否侵及颅底,已及颅底受侵的细节,但也存在着一定的局限性。结论　颅底三维CT可常规应用于可疑口腔颌面部肿瘤侵入颅底的检查。     

颅面联合切除侵及颞下凹和中颅底的颌面部肿瘤

目的：探讨手术治疗侵入颞下凹或中颅底的颌面部肿瘤的相关问题。方法：报告５例采用颅面联合切除方法治疗腮腺肿瘤、颧骨巨细胞瘤和三叉神经恶性神经鞘瘤。结果：５例患者手术全部成功。结论：先颅外后颅内的手术方式能减少手术危险性,中颅底处理中不可进入茎突、翼钩连线以内,首选旋转颞肌瓣修复颅底缺损并填塞颞下凹死腔。     

腮腺区与颅内交通瘤的诊治特点

目的　探讨颅面交通瘤的临床特点和手术方法。方法　对 6例颅面交通瘤采用颅面联合手术切除腮腺多形性腺瘤、颞骨骨巨细胞瘤、听神经瘤。结果　 6例患者手术全部成功 ,术后 1～ 3年未见复发及其他不适。结论　先颅内后颅外的手术方式能减少术后感染和有利于发现颅内肿瘤与颅外肿瘤的沟通部位 ,以利于颅内肿瘤完全切除     

颅内,外联合切除颅底区骨巨细胞瘤

为探讨侵犯颅底部骨巨细胞瘤的治疗效果，对近１０年收治的５例该部位的病例作回顾性分析。患者年龄２２～４９岁，平均年龄３６．２岁。４例男性，肿瘤侵犯颅中凹；１例女性，肿瘤破坏枕颈和枕底区。全部病例均采用颅内、外联合途径切除肿瘤，并辅以术后放射治疗。结果表明，侵犯颅底的骨巨细胞瘤可以通过颅内、外联合途径成功地切除，并发症少，无手术死亡率。表明，ＣＴ扫描对于这一部位肿瘤的诊断和手术计划有重要参考意义；术后放疗应作为重要的辅助治疗。     

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颅底肿瘤不易早期诊断,延迟诊断（delay in diagnosis）几乎是100％。由于颅底位置深在,其中又含有诸多重要血管神经。导致该处肿瘤大多数不能常规切取活检。常规穿刺活检由于没有影像指导,可能穿刺不到目标,还可能损伤重要神经血管,风险较高。超声或CT引导下穿刺活检均存在各自的缺点,不易在临床推广。我院自2011年逐步开展导航技术在颅底及面侧深区肿瘤诊治中的应用,取得了一些经验。本文简单介绍了导航的基本原理及该技术在颅底肿瘤穿刺活检中的临床应用体会。     

侵犯颌面部脑膜瘤的诊治

脑膜瘤常来源于蛛网膜的内皮细胞，为典型的脑外生长性肿瘤。当脑膜瘤长大后侵及口腔颌面部，而表现在颌面部的症状比较少见，易引起误诊。因此，我们总结临床上所见的５例颌面部为首发症状脑膜瘤的诊治情况，发现脑膜瘤除了生长缓慢，呈膨胀性生长等良性肿瘤特征外，还能从ＣＴ片中了解肿瘤的范围、边界情况，内部的钙化灶及肿瘤与颅内的关系，而为进一步的手术治疗提供依据。我们认为ＣＴ是目前诊断脑膜瘤最有效方法之一。治疗以手术为主，对向颅内生长的脑膜瘤采用功能性进颅术，以减少术后颅内并发症的发生，避免术后的肿瘤复发     

超声联合CT导航行颅颌面颈部金属异物取出术32例临床分析

目的：研究超声联合CT导航行颅颌面颈部金属异物取出术的手术方法和临床疗效。方法：回顾分析32例颅颌面颈部金属异物滞留患者的临床资料,通过超声联合CT导航实施异物取出。结果：32例患者的颅颌面颈部共滞留金属异物194颗,其中通过超声导航取出36颗,通过CT导航取出153颗,取出率达97.4%;术中定位准确,出血量少,术后患者均无明显手术并发症。结论：采用超声和CT导航,可精确定位并安全取出滞留于颅颌面颈部的金属异物,避免损伤重要的生理解剖结构,取得了良好的临床疗效。     

Le-fort I access osteotomy to nasopharyngeal tumor – A case-report

Removal of extensive central skull base and paranasal sinus tumors is a significant challenge that is often hampered by limited access and exposure. The safety and efficacy of the Le Fort I osteotomy approach to the skull base have been well established. The purpose of this article is to describe the use of Le fort-1I osteotomy as an access procedure to reach tumors in the nasopharyngeal region in a young patient. The large mass which he presented within the nasopharyngeal region, later diagnosed to be juvenile nasopharyngeal angiofibroma, posed a challenge for surgical access.     

Control of cerebrospinal fluid otorrhea via C-arm-guided reduction of the zygomatic arch as a part of the temporal bone: interdisciplinary approach to an unusual craniomaxillofacial fracture

Maxillofacial fractures are often associated with blunt head injuries, of which skull base trauma is a common component. However, most oral and maxillofacial surgeons do not provide definitive management of temporal bone fractures involving the skull base and their sequelae. Persistent cerebrospinal fluid (CSF) leakage that is refractory to conservative measures usually requires surgical closure to decrease the risk of meningitis. In general, reduction of the displaced fragment of the skull base in temporal bone fractures is not considered a priority. We describe an unusual case of craniomaxillofacial injury exhibiting CSF otorrhea because of a temporal bone fracture with a fragment that included the zygomatic arch. The persistent traumatic leakage was stopped after C-arm-guided reduction of the depressed zygomatic arch. This technique facilitated minimal and only necessary manipulation, without overcorrection, thereby avoiding additional damage to the surrounding tissues. The present case illustrates the definitive contribution of therapeutic measures based on maxillofacial surgery as part of an interdisciplinary approach to the management of the complications of severe head injuries; more invasive neurosurgery was thus avoided.     

CT features of synovial chondromatosis in the temporomandibular joint

OBJECTIVE: The purpose of this study was to determine the characteristic computed tomography (CT) findings of synovial chondromatosis of the temporomandibular joint (TMJ). STUDY DESIGN: Eight subjects with synovial chondromatosis were examined with axial and coronal CT scans. All lesions were histopathologically confirmed either through an arthroscopic punch biopsy or surgery. CT appearances of the lesions were reviewed and classified. RESULTS: Among the 8 subjects, 7 (87.5%) demonstrated soft tissue swelling, 7 (87.5%) showed loose calcified bodies, and 6 (75%) had bony changes of the articular surfaces. Patterns of the skull base changes as well as intracranial extension of the disease were identified. CONCLUSIONS: Based on the CT findings, synovial chondromatosis of the TMJ is characterized by soft tissue swelling, loose calcified bodies, and bony changes of the skull base. The latter may lead to destruction of the central skull base and intracranial extension.     

口腔颌面部肿瘤侵犯翼腭间隙的CT检查和诊断

为了给临床治疗提供有益的经验，作者回顾分析了３３例经病理检查证实的口腔颌面部肿瘤侵犯翼腭间隙的ＣＴ表现，结果显示翼腭间隙区肿瘤侵犯的ＣＴ表现主要是软组织肿块的占位和其各壁结构破坏，不同中心部位的口腔颌面部肿瘤对翼腭间隙的侵犯具有不同的ＣＴ表现特点。作者从组织发生和ＣＴ表现两方面对原发性翼腭间隙肿瘤进行了探讨，并提出了ＣＴ诊断标准。ＣＴ对诊断该区的病变具有重要作用。     

口腔颌面肿瘤侵犯翼腭间隙的CT检查和诊断

为了给治疗提供有益的经验，作者回顾分析了３３例病理检查证实的口腔颌面部肿瘤犯翼腭间隙的ＣＴ表现，结果显示腭间隙区犯的ＣＴ表现主要是软组织肿块的占位和其各壁结构破坏，不同中心部位的口腔颌面部肿瘤对翼腭间隙的侵犯具有不同的ＣＴ表现特点。作战人组织发生和ＣＴ表现两方面对原发性翼腭间隙肿瘤进行了探讨，并提出了ＣＴ诊断标准。ＣＴ对诊断该区的病变具有重要作用。     

Maxillofacial fractures masking traumatic intracranial hemorrhages

Maxillofacial trauma may mask intracranial injuries prompting intensive care treatment. The purpose of this study was to identify whether craniofacial fracture patterns predispose patients with maxillofacial fractures to different types of intracranial hemorrhages. Within 7 years, 6649 patients with craniomaxillofacial injuries were admitted for treatment. The charts of the patients were analyzed according to age, sex, cause and mechanism of injury, type and location of facial injury, and intracranial trauma; 2195 sustained maxillofacial fractures. Statistical analyses were followed by logistic regression analyses for the four main types of intracranial hemorrhage to determine the impact of the different maxillofacial fractures. Intracranial hemorrhages in 212 patients (9.7%) occurred as epidural (2.5%), subdural (4.3%), subarachnoid (5.3%), and intracerebral hemorrhages (6.3%). Le Fort, orbit, nose, zygoma, and maxillary fractures increased the risk for accompanying intracranial hemorrhage by two- to fourfold (P < 0.05). Basal skull fractures caused a multiplication of the risk up to 17-fold, while fractures of the cranial vault were associated with a risk up to 14-fold. Nearly 10% of patients with craniomaxillofacial fractures sustain intracranial hemorrhages requiring frequently immediate neurosurgical intervention. Those patients, suffering from central midface fractures and skull base fractures, are prone to highly significant elevated risks of intracranial hemorrhage.     

三维CT在颅底影像诊断中的应用

目的　探索三维 Ｃ Ｔ 成像在颅底中的应用价值。方法　对２５ 个病例的颅底行 Ｃ Ｔ横断扫描,采用表面阴影显示（ Ｓ Ｓ Ｄ）法进行颅底骨三维重建,分析病变引起颅底骨质改变在三维重建图像上的表现。结果　４ 例颅底骨折的三维重建提供了更多的骨折征象。１５ 例颅底病变术前或术后三维重建为手术方案制定、术后评价、随访及进一步治疗提供了客观真实的立体参考资料。６ 例三叉神经痛射频治疗过程中三维重建有利于制定更安全可靠的穿刺进针线路。结论　在二维 Ｃ Ｔ 基础上的三维成像对检查解剖结构复杂而不规则的颅底是非常有意义的 。     

Ganglioneuroma of the base of the skull

Ganglioneuromas are rare benign tumors originating from the ganglion cells of the sympathetic and parasympathetic nervous system. Ganglioneuromas in the base of skull are extremely rare. In this article, we describe a case of primary ganglioneuroma below the foramen ovale observed in a 38-year-old man. The lesion was asymptomatic. The patient underwent surgical intervention for diagnostic and therapeutic purposes. Craniomaxillofacial surgery was conducted by the oral and maxillofacial surgical team and the neurosurgical team. Combined frontotemporal-preauricular infratemporal approach was used to expose the lesion. Cerebrospinal fluid leakage and facial paralysis did not occur postoperatively. The results of histopathologic examination indicated that the excised lesion was a ganglioneuroma. Clinical follow-up was done, and no recurrence has been observed up to now.     

Computer assisted tumour resection of the skull base: case report

This case report demonstrates computer assisted resection of a skull base tumour after combined chemotherapy and irradiation, in a 40-year-old man with a squamous cell carcinoma of maxilla, zygoma, orbit and skull base. The resection of the skull base was performed with computer assistance after conventional resection of the maxilla, midface, exenteration of the orbit and lymph node dissection. Following combined chemotherapy and irradiation, the original, pretherapeutic tumour extent was marked on the new, presurgical CT scan enabling resection of the skull base with the use of a navigation microscope. Thus planned resection from the presurgical CT could be transposed intraoperatively using the navigation system, and the skull base could be resected with precision.     

Case report: fusion of positron emission tomography (PET) and computed tomography (CT) images for image-guided endoscopic navigation in maxillofacial surgery: clinical application of a new technique.

INTRODUCTION: Surgery based on computed tomography (CT) data is becoming increasingly important in the head and neck region. The technique for hardware fusion between positron emission tomography (PET) and computed tomography (CT) has only been established commercially in the last 4 years. The advantages over CT alone are obvious. The surgeon is simultaneously provided with a map of anatomical as well as of functional (metabolic) details. The fused images offer improved localization of malignant lesions and improved targeting of biopsy, especially for small lesions. PURPOSE: A new technique for image-guided tumour localization for maxillofacial surgery based on PET/CT-image fusion is described. PATIENT AND METHOD: A 78-year-old woman was admitted to this department with a tumour of the skull base. Three dimensional fusion of computed CT with positron PET images on a commercially available navigation system is described. After patient-to-image registration, a high-resolution endoscope was calibrated intraoperatively. Image-guided biopsy specimens were taken under direct visual control. CONCLUSION: PET/CT-image fusion proved extremely helpful to navigate the endoscope to the target lesion and to identify the tumour.