耳前颞蝶径路颅底手术及其缺损修复

目的探讨颅底肿瘤的手术途径。方法采用经耳前“∩”形切口行颞蝶进路切除前颅底、侧颅底良、恶性肿瘤１０例，其中９例同时利用同一术野的颞肌及筋膜瓣修复颅底或鼻咽缺损。结果８例恶性肿瘤随诊２～７年：其中７例随诊３年以上，５例无复发，健在，术后３年复发２例（皆为６次术后复发再复发）中１例死亡，１例带瘤生存；１例随访２年无复发，健在。２例良性肿瘤无复发。９例修复缺损的颞肌瓣除１例坏死外，其余皆取得较好的临床效果，无其它并发症。结论耳前“∩”形切口行颞蝶进路，切口暴露范围大，损伤小，术中可用同一术野的颞肌瓣修复颅底或鼻咽部缺损，术后瘢痕隐蔽，不影响美观，因此可有选择地用于颅底肿瘤的手术治疗。

Skull base operations via pre auricular temporo sphenoidal approach and reconstructions of their defects

Objective To study the surgical approach for cranial base tumors removal. Methods Ten cases of cranial base tumors were thoroughly resected via pre auriculal temporo sphenoidal approach. Among them, 9 cases with defects of cranial base or nasopharynx were reconstructed with the temporal muscle and fascia in the same operative field.Results Patients were followed up from 21 months to 7 years. In 2 cases with recurrent cranial base tumors 1 died of recurrence, 1 lived with the tumor. Eight cases achieved good clinical results without severe complications except 1,who got necrosis of temporal muscle. Conclusion The preauricular temporo sphenoidal approach not only provides an excellent exposure to the compartments of the skull base with a limited injury to the normal tissues, but also offers a convenient way in reconstructing defects with temporal muscle in the same operative field. The incision scar is hidden and the eosmetic affect small. It has been shown that the approach can offer some advanteges in surgical treatment of cranial base tumors selectively.