手术切除从颅底侵犯海绵窦的肿瘤

目的探讨手术切除侵犯海绵窦的颅底肿瘤的指征及手术要点。方法自1998年11月至2002年5月，中日友好医院神经外科与中国医学科学院肿瘤医院头颈外科合作，连续切除侵犯海绵窦的颅底肿瘤32例，其中鼻咽纤维血管瘤7例，脊索瘤5例，鼻咽癌和鼻咽囊腺癌5例，副鼻窦癌5例，神经鞘瘤3例，嗅神经母细胞瘤1例，颞下翼腭窝低分化癌2例，颞下翼腭窝肉瘤3例，恶性纤维组织细胞瘤1例。23例曾经1次或多次手术切除后复发。对临床资料进行回顾性总结。结果根据肿瘤主体的部位分别选用经上颌骨入路、颞下耳前入路、或额眶入路。全部病例术中显露满意，肿瘤均得到肉眼切除，受累的颅神经一并切除，无手术死亡，术后无偏瘫等严重并发症。、术后辅以放射治疗。随访3—50个月，平均19个月，失访3例，4例术后3—6个月死亡，4例带瘤生仔，21例健在。结论由下向上侵犯海绵窦的颅底肿瘤可以手术切除，近期效果满意。对颅底正常和病理性解剖结构的熟练掌握以及多学科医生的密切协作是手术取得成功的关键。

Surgical removal of the skull base tumor with cavernous sinus invasion

Objective To investigate the capability of surgically removing skull base tumor with cavernous sinus invasion, the indications and the key point of the operation. Methods Through transmaxillary, subfrontal-orbital, or preauricular subtemporal-infratemporal approach, 32 consecutive cases of skull base tumor with cavernous sinus invasion were removed safely from the bottom of the skull base in China-Japan Friendship Hospital and Cancer Hospital during November of 1998 and May of 2002. The clinical data were reviewed. Results The patients involved in this group were 7 angiofibroma, 5 chordoma, 5 nasopharyngeal carcinoma or cystic adenocarcinoma, 5 nasal sinus carcinoma, 3 Schwannoma, 1 olfactory epithelioblastoma, and 6 poor differentiated carcinoma or sarcoma. The tumors could be totally removed in all cases under surgical microscope. There were no perioperative mortality and morbidity. Most of the cases had to sacrifice one or more involved cranial nerves, but the internal carotid artery (ICA) could be saved in 31/32 patients. Of the 17 cases with malignant tumor, the entire cavernous sinus with cranial nerves and ICA were removed only in one case. Since we could not get enough safe border on the site of the cavernous sinus, postoperative radiation therapy was given for those patients with malignant tumor. The follow up period are 3-50 months in 29 patients with mean period of 19 months. Of these 29 patients, 4 died of tumor recurrence in 3-6 months after operation, 4 live with recurrent tumor 7-24 months after operation, 21 patients are tumor free at last follow up and back to there routine life. Conclusions The skull base tumor with cavernous sinus invasion could be removed successfully through various approaches. For this kind of tumors, dissecting cavernous sinus could be done more easily from its bottom than from intracranial. The exposure is wide and satisfactory . The lesion as well as the important anatomy structures can be viewed directly and clearly. The close cooperation between neurosurgeon and head and neck surgeon is one of the key points for this kind of difficult operation.