前颅底肿瘤手术入路

目的：探讨前颅底肿瘤手术入路，提高手术效果。方法：对37例前颅底肿瘤进行了相应的手术切除，颅面联合入路21例，其中额颅合并鼻侧切开1例，上颌骨内侧部分切除或暂移开切除肿瘤7例，上颌骨切除8例，上颌骨或（和）眶或（和）颌面皮肤切除5例；上颌骨部分或全外旋合并鼻锥转位13例；鼻额翻瓣、额眶入路及面中揭翻各1例。结果：10例良性肿瘤患者均健在，恶性肿瘤患者3、5年存活率分别为81．9％（22／27）、62．9％（17／27）。9年以上无瘤存活1例。结论：除鼻侧切开外不同类型颅面联合入路均能提供良好的肿瘤显露，有利于鼻颅沟通瘤的整块切除。部分或上颌骨全外旋合并鼻锥转位适于切除累及颅底尚未侵及颅内的肿瘤。额鼻共同翻开适于切除额窦发育良好的鼻颅沟通瘤。颅眶入路适于颅眶沟通瘤。面中揭翻应选择应用。

Surgical approaches of anterior skull base tumors

Objective:Study for surgical approaches on anterior skull base tumors.Method:All 37 cases with anterior skull base tumors were surgically treated.Twenty-one cases were treated with anterior craniofacial approaches:Frontosubcranal combined with total maxillectomy in 8 cases or/with orbital exenteration in 5 cases,combined with lateral rhinotomy in 1 cases,combined with nasotranslocation with medial maxillectomy in 7 cases.Partial or total maxillary swing combined with nasopramid translocation in 13 cases.Frontonasal,fronto-orbital and midface degloving in one case respectively.Result:Of the 27 malignant cases the 3 and 5-year survival rates were 81.9%(22/27)and 62.9%(17/27)respectively,and one tumor free case living well more than 9 yers.There were no recurrence in 10 cases with benign tumor.Conclusions:Various craniofacial approaches except lateral rhinotomy provide directly satisfactory tumor exposure and facilitate enbloc resection of the nasoparanasal sinus tumor with intracranial extension.Partial or total maxillary swing combined with nasopramid translocation is good for tumor involving the skull base without intracranial invasion.The fronto-nasal pyramid translocation is good for removal of the upper part of nasal tumor with intracranial extension on well developed frontal sinus.The fronto orbital approach is proper for removal of fronto-sphenoid tumor and midface degloving may be used in selected cases.