10例前颅底肿瘤的术式分析

目的：探讨鼻锥体下翻额正中进路前颅底肿瘤切除术在前颅底肿瘤中的应用。方法：颅面联合进路前颅底肿瘤切除术2例；经额下进路颅-眶-鼻沟通性肿瘤切除术3例；鼻侧切开术3例；鼻锥体下翻额正中进路前颅底肿瘤切除加额骨膜、髂骨瓣颅底修复和重建2例。结果：10例患者均完全切除瘤体，经1～5年随访，良性肿瘤6例无复发。恶性肿瘤4例中，1例随访1年生存良好；余3例中生存3年2例，5年1例。结论：前颅底肿瘤需要根据肿瘤的大小、位置及性质选择最佳的手术进路。鼻锥体下翻额正中进路前颅底肿瘤切除术可在明视下进行手术操作，对额叶损伤轻，颅底修复方便，是一有价值的手术进路。

Different surgical management of tumors in the anterior skull base:a report of 10 cases

Objective:To study the different surgical approach for the resection of tumors in the anterior skull base and to introduce an approach of the frontal mid-line incision with the nasal pyramid over-turned downward.Method:A review of 10 tumors in the anterior skull base employed unlike operative approach was presented. Of the 10 cases, 6 cases were benign tumors and 4 cases were malignant tumors. Two cases underwent the combined craniofacial approach, 3 cases the subfrontal approach, 3 cases the lateral rhinotomy approach, 2 cases the approach of the frontal mid-line incision with the nasal pyramid over-turned downward.Result:All tumors were totally resected. All patients were followed up from 1 to 5 years. In the benign tumors group, 6 cases achieved good results and no recurrence. Of the 4 cases with malignant tumors, 1 cases were followed up 1 year and is alive,2 cases survived after 3 years and 1 case died after 5 years. Three cases died from local recurrence or invaded intra-cranial.Conclusion:According to the site, range and pathology of the skull base tumors, the best operative approach should been selected. The approach of the frontal mid-line incision with the nasal pyramid over-turned downward is closer to tumor and easy to repair duramater,has fine exposure of the anterior skull base, minimal retraction of the frontal lobe, and has better clinically worthy.