鼻颅底沟通性肿瘤的诊断及外科治疗

目的 探讨鼻颅底沟通性肿瘤的诊断及外科治疗方法。方法 回顾性分析2011年1月—2021年12月华中科技大学同济医学院附属同济医院神经外科诊治的37例鼻颅底沟通性肿瘤的临床资料，男23例，女14例；年龄6~67岁，平均年龄49岁。其中恶性肿瘤27例，良性肿瘤10例，肿瘤直径4.7~8.5 cm，平均直径6.3 cm。所有患者均采用头颈部影像学检查协助诊断后行开颅显微手术+颅底重建，恶性肿瘤术后进一步行放化疗，术后所有患者均定期随访，恶性肿瘤随访5~10年，平均8.3年；良性肿瘤随访1~11年，平均6.7年。结果 所有患者均顺利完成手术，无严重并发症，恶性肿瘤5年生存率63.0%(17/27)；1例良性肿瘤(非典型脑膜瘤)术后5年复发再次经双侧额底入路手术治疗。结论 神经外科首诊的鼻颅底沟通性肿瘤往往颅内肿瘤为主体，开颅手术全切或大部分切除+妥善颅底修复意义重大。

Diagnosis and surgical treatment of communication tumor of nasal skull base

Objective To explore the diagnostic and surgical methods of communication tumor of nasal skull base.Methods Clinical data of 37 patients who underwent resection of communication tumor of nasal skull base from Jan 2011 to Dec 2021 in the Department of Neurosurgery, Tongji Hospital, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology were analyzed retrospectively. Of them, 23 were male and 14 were female, aged from 6 to 61 years old with an average of 49. There were 27 cases of malignant tumor and 10 cases of benign tumor. The maximal diameter of the tumor varied from 4.7 to 8.5 cm with an average of 6.3 cm. All cases had a series of preoperative imaging examinations and underwent craniotomy plus skull base reconstruction as well as long-term follow-up. Patients with malignant tumor had been followed up from 5 to 10 years, with a mean of 8.3 years, while those with benign tumor from 1 to 11 years, with a mean of 6.7 years.Results Surgical treatment was completed successfully without major complications in all the patients. The five-year survival rate of the patients with malignant tumor was 63.0%(17/27). Five years after operation, recurrence occurred in one patient with benign tumor (atypical meningioma), and reoperation was performed via bilateral frontal fundus approach.Conclusions The communication tumor of nasal skull base in neurosurgery department mostly locate in the skull. The total or subtotal resection by craniotomy followed with proper skull base reconstruction is of great significance.