颅前窝内外沟通性肿瘤切除术后的颅底重建

目的总结手术切除颅前窝内外沟通性肿瘤后颅底重建的方法。方法回顾性分析21例颅底肿瘤切除术后的颅底重建经验。对颅底小缺损（〈1.0cm×1.5cm）,行颞肌筋膜修补7例;对颅骨大缺损（≥1.0cm×1.5cm）,采用“四步法”行颅底重建：第一步取自体脂肪填塞肿瘤切除后的残腔;第二步用带血管蒂骨膜瓣覆盖颅底骨缺损,边缘严密缝合于周围硬脑膜;第三步用自体骨或钛板等颅骨修补材料修补骨缺损;第四步取自体筋膜修补硬脑膜;本组14例。结果颅底缺损修补均获得满意效果。术后脑脊液漏1例,经腰穿置管引流后痊愈。术后3个月出现局部感染1例,经抗炎治疗后缓解。无局部脑膨出、脑膜炎等并发症发生。结论“四步法”重建颅底简单易行,能有效预防脑脊液漏、局部脑膨出和脑膜炎等并发症的发生。

Skull base reconstruction after resection of tumors communicating the intra-and extra-anterior cranial fossa

Objective To summarize the methods for skull base reconstruction after resection of the tumor communicating the intra- and extra-anterior skull base tumors. Methods The experience with skull base reconstruction in 21 patients with tumor communicating the intra- and extra-anterior skull base was analyzed retrospectively. Seven patients with small skull base defects （〈 1.0 cm × 1.5 cm） received temporalis fascia patches, while the other 14 patients with large skull base defects （≥1.0 cm × 1.5 cm） underwent following four-step skull base reconstruction： 1） padding the cavity after tumor removal with autologous fat; 2） covering the skull base defects using pericranial flap with vascular pedicle, and closely sutured to the surrounding dura; 3） repairing the bone defects with skull repair materials, such as autogenous bone graft and titanium plate; 4） repairing the dural defect with autologous fascia. Results All patients got satisfactory results. One patient with cerebrospinal fluid leakage recovered well after lumbar puncture and catheter drainage. One.patient suffered local infection 3 months later and the symptoms were relieved after anti-inflammatory treatment. No complications such as brain hernia and meningitis occurred. Conclusion The four-step procedure for anterior skull base reconstruction is simple and easy to practice, and could effectively prevent postoperative cerebrospinal fluid leakage, brain hernia and meningitis.