神经导航在颅底肿瘤手术中的应用

目的评价神经导航系统在颅底肿瘤手术中的应用.方法在74例颅底肿瘤手术中,应用StealthStation神经导航系统指导手术操作.术中应用神经导航实时定位颅底解剖标志点并判断肿瘤切除程度.结果74例平均坐标误差为(2.26+-0.99)mm,预期准确性为(3.00±0.92)mm.CT和MRI融合误差为1.04 mm.靶点准确性为＜2 mm.74例肿瘤全切55例,次全切除10例,大部切除8例,穿刺1例.术后症状改善或无变化61例(61/74),加重或出现新症状13例.2例死于与手术无关的原因,分别为窒息和多器官功能衰竭.结论在颅底肿瘤手术中,神经导航定位准确可靠,有助于提高肿瘤切除率,降低手术并发症.     

后颅底肿瘤的显微外科手术治疗

目的：观察显微外科手术治疗颅底肿瘤的疗效并提高对其治疗的认识。方法：30例后颅底肿瘤患，全身总体情况分级为Ⅰ级18例，Ⅱ级10例，Ⅲ级2例；术前神经功能分级为Ⅰ级5例，Ⅱ级7例，Ⅲ级15例，Ⅳ级3例。全部患均的显微镜下行后颅底肿瘤切除手术。结果：30例患病理学分类为听神经瘤（12例）、脑膜瘤（10例）、表皮样囊肿（4例）以及畸胎瘤、神经鞘瘤、脊索瘤和滑膜肉瘤（各1例）。肿瘤全切除16例，次全切除5例，大部切除9例。疗效优24例（80.00%），良4例（13.33%），差1例（3.33%），死亡1例（3.33%）。结论：术前精确诊断对手术的成功及预后非常重要。手术入路主要取决于肿瘤的位置、延伸范围及大小。显微外科手术可减少术后并发症，预后良好。     

神经导航融合技术在颅底肿瘤中的应用

目的 探讨神经导航融合技术在颅底肿瘤中的应用。方法 通过术前准备、注册、CT与MRI等影像模式融合、术中导航定位,比较各种注册方法的精确性,融合精确度,术中定位精确性、术中持续精确性,扩大暴露范围等,提出和改进神经导航技术在颅底手术中的应用技术。结果 神经导航用于颅底肿瘤手术切除,术前有助于开颅皮肤切口及骨瓣的设计,选择最短的手术途径;术中可为肿瘤的切除定向定位,在颅底手术中使术者随时了解颅底肿瘤与周围重要解剖结构（如脑干、颅神经及重要血管等的关系）。结论 颅底肿瘤以及颅底结构位置相对固定,影响因素较小,脑移位最小,定位精确,及时反馈肿瘤的切除深度,增加手术的安全性,加快手术进程,避免脑重要结构的副损伤。     

颅底肿瘤的放射治疗进展

颅底肿瘤常常难以手术全切除，放射治疗是颅底肿瘤术后残留和／或复发以及全身状况不允许手术患者的主要治疗手段。常规分割放射治疗因受放射剂量的限制而治疗效果不理想；γ－刀、Ｘ－刀治疗较小体积（≤３ｃｍ）的颅底肿瘤时能精确聚焦照射毁损病灶而周围组织接受的剂量很少，达到类似于手术一次切除的效果。立体定向放射治疗更符合临床放射生物学的要求，而且降低了邻近颅底肿瘤的颅神经损伤率；适形调强放射治疗通过满足形状适形和放射剂量适形的要求，进一步提高了颅底肿瘤局部控制率、患者生存率以及安全性。此外，由于新的医用放射源如质子、中子、α－粒子和负Л介子等的不断涌现，颅底肿瘤放射治疗作用将更大、毒副作用更低。     

颅底肿瘤术后预防性应用止血药的临床观察

目的探讨颅底肿瘤术后预防性应用止血药物的临床效果。方法选择40例择期手术的颅底肿瘤患者，按术后治疗方法不同分为预防性应用止血药组（治疗组n=20）和不用止血药组（对照组n=20），术后2～7d行CT复查，测定术后24h硬膜外引流量，统计术后腰穿使肌性脑脊液颜色变为淡黄半透明所需腰穿次数及放出血性脑脊液量，术后颅内出血及脑梗塞并发症例数。结果术后CT复查均无颅内血肿，两组硬膜外引流量、腰穿次数、放出血性脑脊液量差别无显著性（P〉0．05），治疗组术后并发症两例。结论两组间无明显差异，颅底肿瘤术后止血药可免用。     

颅底前入路显微外科手术切除颅底肿瘤

位于颅、面、咽等结构之间侵犯颅底邻近部的肿瘤，手术显露困难。我们采用颅底前入路显微外科手术切除4例位于斜坡、蝶窦、筛窦、眶后等处的肿瘤，现报告如下。     

106例颅底肿瘤并三叉神经痛

本文报告了106例颅底肿瘤并三叉神经痛。其中胆脂瘤83例,三叉神经鞘瘤11例,脑膜瘤5例,三叉神经纤维瘤3例,脑干胶质瘤、听神经瘤各2例。桥小脑角胆脂瘤多表现为典型三叉神经痛或唯一症状,其它多表现为非典型三叉神经痛。分析了不同肿瘤诊断和手术要点,总结了提高治愈率减少并发症的经验。     

鼻内镜下经鼻颅底肿瘤切除术后并发症的治疗及护理

颅底肿瘤指的是颅底与其相邻结构生长的肿瘤,肿瘤生长可能从颅内向颅外,也可从颅外向颅内,破坏颅底骨质或经颅底裂孔后生长于颅内[1]。手术切除是治疗颅底肿瘤最有效的手段,但传统切开手术造成创伤较大,手术过程中牵拉和触动脑组织或在入路途径中牺牲重要结构组织,易造成永久性听力丧失及面瘫等严重并发症。随着鼻内镜技术的成熟完善,其在颅底肿瘤手术中的应用具有微创、直接、术后恢复快等优势[2],逐渐被外科医生认可。值得注意的是,鼻     

颅底肿瘤术中运动颅神经监护和预后评估

图1肌电发放动作电位颅底肿瘤位置深在,与脑干和颅神经关系密切,如何在切除肿瘤的同时,尽可能保留脑干和颅神经功能,成为现代神经外科的一大研究方向。本文对近一年来我院收治的18例不同部位颅底肿瘤进行术中运动颅神经诱发肌电图(stimulatedelectromyography,SEMG)监护,取得了良好的治疗效果,现报告如下。临床资料与方法1. 一般资料:2002年2月至2003年5月资料完整的实行术中SEMG监测的颅底肿瘤患者18例,男8例,女10例,年龄28～69岁,平均41.6岁。其中,鞍旁脑膜瘤2例,听神经瘤6例,桥小脑角脑膜瘤4例,岩斜区脑膜瘤2例,颈静脉孔区神经鞘瘤2…     

岩骨巨大肿瘤切除及颅底重建

目的 总结和分析2例岩骨巨大肿瘤切除经验及颅底重建体会.方法 1例岩骨腺样囊性癌.由于岩骨外1/3及部分周围颞骨受侵蚀,在保护好面神经及内耳结构的情况下,将肿瘤全切.严密修补硬膜,用周围的颞肌、头夹肌、胸锁乳突肌填塞瘤腔重建颅底.另1例是岩骨黏液性肿瘤,约10cm×10cm×12cm大小,内达岩骨尖部,中、后颅窝均受累及,同侧面、听神经功能障碍.术中在保护好颈内动脉的前提下,显微镜下全切肿瘤.巨大的瘤腔用带蒂的斜方肌肌瓣填塞重建颅底.结果 2例患者术后第2天均出现皮下积液,经穿刺抽吸,加压包扎,腰大池引流治愈.第1例术后3个月行放疗,1年后复查2例无复发,恢复正常工作.结论 术前要依据肿瘤大小设计好切口,术中要仔细耐心,注意重要结构的保护;硬膜有破损要修补严密.颅底重建应用带蒂的斜方肌肌瓣为好,既可以根据需要大小可自由切取,有因皮肤缺损的也可以转移皮肌瓣.还有其抗感染力、耐受放疗和易存活能力强等优点.     

颅底沟通性肿瘤的外科治疗

目的 探讨颅底沟通性肿瘤的临床特点、手术入路以及术后重建的方法。方法 将颅底划分为不同的区域，按照肿瘤主体累及的部位的不同选用不同的手术入路。采用显微手术，部分辅以内镜切除肿瘤，应用钛板修复颅底骨缺损，近手术区域筋膜、骨膜瓣翻转和背阔肌游离肌皮瓣移植血管吻合修复术后颅底和颅颌面的脑膜缺损和软组织缺损。结果 本组43例，肿瘤全切除32例，近全切除7例，部分切除4例，术后40例临床症状改善，并发症主要为颅神经损伤6例。术后门诊随访30例，随访时间5—20个月，平均9个月，复发3例，无脑脊液漏、颅内感染及其他严重并发症。结论 颅底沟通肿瘤的外科治疗较复杂，选用个性化的手术入路，精细的显微操作，配合使用内镜，加之可靠的颅底修复与重建，可以获得较好的临床疗效。     

内镜经鼻前颅底肿瘤的外科治疗

目的总结内镜经鼻入路切除前颅底肿瘤的经验。方法回顾性分析2003年11月～2006年5月18例肿瘤侵犯前颅底的临床资料．其中14例单独采用内镜经鼻手术入路．4例采用颅鼻联合入路进行了治疗。病理类型包括：脑膜瘤2例，脊索瘤1例，视神经鞘瘤1例．骨纤维异常增殖症1例．鳞状细胞癌3例，嗅神经母细胞瘤3例，腺样囊性癌1例，恶性骨巨细胞瘤1例，脊索肉瘤1例．神经内分泌小细胞癌1例，透明细胞癌1例，甲状腺癌颅底转移1例，腮腺癌颅底转移1例。结果经术中镜下及术后影像学检查证实17例肿瘤被全部切除．1例大部分切除。2例术后出现脑脊液鼻漏，经保守治疗后痊愈。无颅内出血、感染及死亡病例。结论内镜经鼻入路能够充分显露和切除前颅底肿瘤．且大多数病例无需处理硬脑膜及进行颅底重建。     

Microsurgical free flaps for skull base reconstruction following tumor resection: Available techniques and complications

IntroductionResection of malignant tumors located in the anterior and middle fossae of the skull base requires thorough anatomical knowledge, as well as experience regarding the possible reconstructive options to resolve the resulting defects. The anatomical and functional relevance of the region, the complexity of the defects requiring reconstruction and the potential complications that can occur, represent a true challenge for the surgical team. The goal of this study is to describe the microsurgical reconstructive techniques available, their usefulness and postoperative complications, in patients with malignant tumors involving the skull base.Materials and methodThis observational, retrospective study, included all patients who underwent surgery for malignant craniofacial tumors from January 1st, 2009 to January 1st, 2019 at a University Hospital in Argentina. Only patients who required reconstruction of the resulting defect with a free flap were included.ResultsTwenty-four patients required reconstruction with FF; 14 were male (58.3%) and mean age was 54.9 years. Sarcoma was the most frequent tumor histology. Free flaps used were the following: anterolateral thigh, rectus abdominis, radial, latissimus dorsi, iliac crest and fibular. Complications occurred in 6 cases and no deaths were reported in the study group.ConclusionFree flaps are considered one of the preferable choices of treatment for large skull base defects. In spite of the complexity of the technique and the learning curve required, free flaps have shown to be safe, with a low rate of serious complications. For these patients, the surgical resolution should be performed by a multidisciplinary team.     

前侧颅底沟通肿瘤的手术治疗

目的探讨前侧颅底颅内外沟通瘤的手术策略、技巧。以提高手术疗效。方法回顾性分析经手术治疗的前侧颅底沟通肿瘤50例，着重于肿瘤部位、范围、病理与病例选择、术前计划、入路选择、手术技巧等之间的关系。结果肿瘤全切31例，次全切15例，部分切除4例。术后出现并发症23例，无死亡病例。绪论根据肿瘤病理类型、位置、范围选择合适手术入路。利用不同工具和方法，争取一期全切肿瘤。重建颅底硬膜及颅骨结构，避免脑脊液漏。保留功能和容貌是手术的关键。     

Treatment outcomes after surgical resection of midline anterior skull base meningiomas at a single center

Meningiomas of the midline anterior skull base (ASB) typically grow around the optic chiasm. These tumors can displace or adhere to the optic apparatus, resulting in visual abnormalities. For this reason, in most studies of surgically resected meningiomas, only surgical and visual outcomes have been evaluated. However, in this study, we assessed overall clinical outcomes and the effects of different surgical approaches on outcomes. Clinical data for 126 patients who were treated surgically for midline ASB meningiomas between 1994 and 2009 were collected and reviewed retrospectively. The mean follow-up duration was 39 months (range: 0.5–146 months). Most procedures were performed via a pterional approach and did not require an aggressive skull base approach. Clinical outcomes were evaluated using our own criteria, and potential predictive factors for visual and clinical outcomes were tested statistically. The tumor control rate was 83% (105/126). Immediate postoperative visual status and optic canal involvement were correlated with visual outcome. Of the patients who ultimately had improved visual status, only six were originally categorized as having severe visual impairment (all were only able to count fingers). In terms of clinical outcome, 41 patients were classified as “excellent”, 32 as “good”, 29 as “fair”, and 20 as “poor”. A symptom duration of less than six months, less severe preoperative visual symptoms of the affected eye, and the extent of resection were all correlated with improved clinical outcome. Involvement of the optic canal, adherence of the tumor to the optic nerve, and major arterial encasement by the tumor were associated with poor clinical outcome. We recommend that in patients with unilateral severe visual impairment, the focus should be on improving visual function in the contralateral eye. Preoperative and postoperative evaluation of several variables allows for the prediction of clinical and visual outcomes.