侵犯鼻窦的前颅窝底脑膜瘤术中脑脊液漏的预防

目的:介绍侵犯颅底骨质及鼻窦的前颅窝底脑膜瘤的手术方法及颅底重建经验。方法:回顾性分析13例患者的临床资料。大冠状或小冠状皮瓣开颅,骨膜向前完整分离,分块切除肿瘤后,咬除或磨除颅底受侵蚀及增生的骨质,将突入鼻窦内的肿瘤切除。切取患者下腹部合适大小的脂肪组织,修剪后填塞入颅骨缺损处,将额骨骨膜翻下,严密缝合骨膜和颅底缺损处周边正常硬膜,用耳脑胶在缝合处粘合一圈。结果:按照Simpson标准,12例Ⅰ级切除,1例Ⅱ级切除。术后并发症包括无菌性脑膜炎3例,额叶症状包括多语、躁动、欣快及缄默3例,无脑脊液漏及颅内感染,无死亡。病理诊断均为良性脑膜瘤,其中2例为细胞增生活跃。随访9个月～8年,平均3.4年,肿瘤无复发。结论:脂肪填塞颅底缺损处,带蒂骨膜与缺损周边正常硬膜严密缝合,用生物胶加固缝合处能有效防止脑脊液漏。     

Proton beam therapy in skull base pathology

The optimal treatment of chordomas is maximal safe resection followed by radiation therapy. Data have shown that the use of protons has increased the local control of chordomas. Because of their physical properties, proton therapy has a sharp decline at its distal range, thereby minimizing collateral damage. However, this choice of radiation therapy has been limited based on the availability of resources. Given the high cost of proton facilities and improved techniques for other forms of radiation therapy, this article evaluates whether proton therapy is still superior to other radiation techniques in the treatment of chordomas.     

Endoscopic surgery of pituitary tumors

Endoscopic pituitary surgery has been gaining wide acceptance as the first-line treatment of most functional pituitary adenomas. This technique has many advantages over traditional procedures, and growing evidence supports its use for endocrine control of functioning tumors. This article reviews data on the different modalities of treatment of functioning pituitary adenomas and compares the results. Endoscopic pituitary surgery controls tumor growth and endocrinopathy as well as or better than other treatment modalities. Complication rates are low and patient recovery is fast. Furthermore, surgery provides a means of achieving prompt decompression of neurologic structures and endocrine remission.     

Modeling of the human fetal skull base growth: interest in new volumetrics morphometric tools

Background

Research on the skull base is important to improve our understanding of the growth and development of the modern human skull. To study the growth of the human fetal skull base, we assessed a new geometric morphometric tool, which does not require the use of bone landmarks.

Material and methods

Seven dry fetal skulls of an estimated gestational age ranging from 15 to 27 weeks were studied. Each skull was scanned using a standard CT scan and the image sets were post-processed to extract volumetric data by segmenting the skull base into predefined regions of interest. Our method of analysis was based on the inertial properties of reconstructed volumes.

Results

The volumetric study of the skulls highlighted an asynchronous speed of growth between the pre and post-chordal parts of the skull base whose preferential growth are in the vertical and horizontal planes. We also found different speeds of growth in the pre-chordal part depending on the type of ossification (endochondral or membranous). The overall shape of the skull base bones were preserved during the period studied except for the petrous pyramids. The expansion of bone parts was isometric with reference to a central point that was located at the intrasphenoidal synchondrosis. Finally, the analysis of the basicranial angles corroborated data from the literature in the sagittal plane and allowed their study also in the frontal and horizontal planes.

Conclusions

This three-dimensional volumetric approach is a necessary complement to studies that are performed in the sagittal plane and are based on the identification of landmarks. The geometric morphometric method used by authors permitted to obtain original informations on the growth kinetics and bone tridimensional movements of the human fetal skull base.     

Colgajos pediculados procedentes de la arteria esfenopalatina: estudio anatómico y quirúrgico

IntroductionLocal pedicle flaps based on the sphenopalatine artery make it possible to reconstruct large defects of the skull base (SB).Material and methodsFrom January 2008 to January 2013, 64 lesions with involvement of SB were analysed. These lesions were treated using endoscopic endonasal approach and required a pedicle flap based on the sphenopalatine artery. In addition, measurements and flexibility of the flaps were examined in 4 cadaveric nasal cavities.ResultsSurgical group. Sixty-four nasoseptal flaps (NSF) were used, in 4 cases associated with a middle turbinate flap (MTF), and in 1 case supplemented with an inferior turbinate flap (ITF). Five cerebrospinal fluid fistulas (8%) were noted. Among patients with initial lesions, 7% presented an anosmia. Cadaveric group. The length of the NSF varied between 5.2 cm and 7.7 cm and the width ranged from 3 cm to 4.5 cm. The ITF provided an anterior-posterior distance between 4.2 cm and 5 cm, with a width between 1.2 cm and 2.8 cm. The mean length of MTFs varied between 3.5 cm and 4.2 cm, with a width between 1.4 cm and 1.9 cm.ConclusionThe most versatile local flap for the reconstruction of skull base defects is the NSF, and flaps pedicled to the posterolateral nasal artery offer an excellent alternative.