头颈外科神经外科联合手术治疗颅底沟通肿瘤

目的 介绍头颈外科与神经外科合作处理颅底沟通肿瘤的经验和优势.方法 回顾性分析2005年7月至2008年7月头颈外科和神经外科联合制定手术方案并共同实施手术54例(良性21例,恶性33例)颅底沟通肿瘤的临床资料,其中前颅底19例,侧颅底12例,中央颅底17例,后颅底(颈静脉孔区)6例.结果 本组颅底沟通肿瘤均一期手术切除.良性肿瘤全切除20例,近全切除1例;恶性肿瘤肉眼全切除25例,6例鼻窦、鼻咽、腮腺恶性肿瘤及2例脊索瘤近全切除.无手术死亡病例,恶性肿瘤并发症13例,其中术后出血2例.随访8～43个月,良性与恶性肿瘤中位随访时间分别为19.1及21.0个月,恶性患者失访3例.21例良性肿瘤复发1例.33例恶性肿瘤中复发12例,死亡9例(其中1例死于心脏病),Kaplan-Meier法统计3年生存率与无瘤生存率分别为53.0%及52.7%.结论 头颈外科和神经外科合作有利于提高颅底沟通肿瘤的手术切除率从而提高治疗效果.

Cooperation management by head and neck surgery and neurosurgery for skull base tumors

Objective To present the experience and advantage of cooperation management by head and neck surgery and neurosurgery for communicating skull base tumors. Methods A review of 54 communicating skull base tumors (benign tumor 21, malignant tumor 33) cooperation resection by head and neck surgery and neurosurgery from July 2005 to July 2008 in the Cancer Hospital of Chinese Academy of Medical Sciences was presented. The tumor originated in the anterior skull base in 19 cases, originated in the lateral skull base in 12, in the central skull base in 17, and in the posterior skull base in 6. Results All procedures were conducted in a single stage by a muhidisciplinary team. Total resection of tumor was achieved in 45 cases, and subtotal resection was achieved in 9. There was no operative death. There were 2 cases postoperative hemorrhage. All cases except 3 were followed up with a period of 8 to 43 months (median, 19. 1 months for benign tumor and 21.0 months for malignant tumor). Three patients with malignant tumor were lost. Twelve cases of malignant tumor and one case of benign tumor recurred postoperatively. Nine patients with malignant tumor had died( one of these died from heart trouble). Three-year disease-free survival rates and overall survival rates of malignant tumor were 52. 7% and 53.0%, respectively. Conclusions It suggested that a special operative team constituted of head and neck surgeon and neurosurgeon may improve the outcome of the difficult skull base tumors.