摘要
颅内外沟通性肿瘤范围广泛,同时累及颅内、颅外多个结构,单一的手术人路常不能充分暴露肿瘤,手术难度很大。本文重点介绍颅-颌面联合入路切除颅内外沟通性肿瘤的手术方法及要点。方法:对22例颅内外沟通性肿瘤采用颅-颌面联合人路进行手术,其中21例一期行颅-颌面成型。(1)颅眶颧入路:即额颞开颅伴眶骨颧骨颧弓截骨术,用于14例颅眶颞下窝沟通性肿瘤。(2)颅前窝底结合鼻侧切人路:用于3例颅-眶-筛窦沟通性肿瘤及2例颅-筛、蝶窦-鼻腔沟通性肿瘤。(3)乳突-乳突后入路:用于切除2例同时累及乳突、外耳道、岩骨及颅内的肿瘤。(4)开颅结合上颌骨切除:用于1例晚期恶性肿瘤同时侵犯颅内、眶内、筛窦、蝶窦及上颌窦,局部用颞肌瓣添充并行植皮。结果:肿瘤全切18例,近全切4例。术后病理诊断为脑膜瘤12例,恶性脑膜瘤2例,神经鞘瘤2例"腺样囊性癌4例,胆脂瘤1例,低分化鳞癌1例。术后除1例外,余没有遗留明显的颅面畸形,复查增强颅MRI或CT检查未发现明显的肿瘤残留病灶,术后行预防性放疗6例。随访3年,复发2例。结论:采用颅-颌面联合人路可以充分的显露颅内外沟通性肿瘤,可基本做到影像学意义上的肿瘤全切,对恶性肿瘤术后辅以放疗可减少肿瘤复发。
BACKGROUND & OBJECTIVE: The tumors involving the intra-and extra-cranial region are neoplasms with difficults to be resected completely through a single approach. We investigated the operative tech-nique of the combined craniomaxillofacial approaches for removing the tumors involving the intra-and extra-cranial region in this article. METHODS: A retrospective study was performed on 22 patients who underwent crainioto-my through combined craniomaxillofacial approaches for treatment of neoplastic diseases. Twenty-one cases have under-gone reconstruction of defects in the craniomaxillofacial skeleton during the operations.1, Fron-to-temporo-orbito-zygomatic approach, fronto-temporal craniotomy with lateral orbital walls and zygoma osteotomy,was performed in 14 cases with neoplasms involving the floor of the anterior and/or middle cranial fossae, orbit, infratemporal fossa. 2, Subfrontal approach with transfacial approach was used in 3 cases with neoplasms involving skull base, orbit, eth-moidal sinus and 2 cases with neoplasms involv-ing skull base, nasal cavity, ethmoidal sinus,sphenoidal sinus. 3, Transmastoid-retromas-toid craniotomy was applied in 2 cases with neoplasms involving mastoid process, external acoustic meatus, petrous pyramid, and inlracranial region. 4, Cranioto-my with maxillectomy was done in one terminal malignant neoplasms involving skull base, orbit, ethmoidal sinus,sphenoidal sinus and maxillary sinus. RESULTS: The tumors were totally removed in 18 cases, sublotally in 4 cases. Pathological diagnosis included meningioma(12 cases), malignant meningioma(2 cases), schwannoma(2 cas-es), adenoid cystic carcinoma(4 cases), and poorly differentiated squamous cell carcinoma(1 case) . There were no postoperative craniofacial abnormality except one case. Postoperative MRI revealed the tumors disappeared in all cases. Six cases have received postoperative radiotherapy. Recurrences of tumor were found in two cases during the follow-up period of 3 years. CONCLUSIONS: The tumors which involving the intra-an
出处
《中国神经肿瘤杂志》
2004年第4期283-286,共4页
Chinese Journal of Neuro-Oncology
关键词
颅-颌面联合入路
颅内外沟通性肿瘤
放疗
恶性肿瘤
Craniomaxillofacial approaches
Tumors involving the intra- and extra-cranial region
Radiothera-py
