摘要
目的 探讨内镜经鼻手术切除颅底脊索瘤后的颅底重建方法。方法 回顾性分析2007年8月至2013年10月使用内镜经鼻手术治疗的146例颅底脊索瘤的临床资料.将颅底缺损根据硬膜缺损大小分为3种类型：（1）硬膜完整113例,主要使用人工材料进行颅底重建;（2）硬膜缺损≤1.0cm 12例,使用自体游离组织（自体游离脂肪、肌肉、肌筋膜）结合人工材料进行多层加固技术颅底重建;（3）硬膜缺损＞1.0cm21例,使用带蒂鼻中隔黏膜瓣结合自体游离组织进行颅底重建。结果 硬膜完整的患者术后发生脑脊液鼻漏为0例（0％）;硬膜及蛛网膜缺损≤1.0cm的患者术后发生脑脊液鼻漏为1例（8.3％）;硬膜和蛛网膜缺损＞1.0cm的患者术后发生脑脊液鼻漏为2例（9.5％）.总体脑脊液鼻漏发生率为2.1％.结论 不同类型的硬膜缺损应选择不同的颅底重建方法;尽量减少鼻腔带蒂黏膜瓣的使用,不但可以减少鼻腔创伤,减少术后鼻腔并发症,增加术后的舒适度,而且可以为肿瘤复发再次手术切除后的颅底重建提供便利。
Objective To describe the techniques for the reconstruction of skull base defects after minimally invasive endoscopic resection of skull base chordomas.Methods The records of 146 patients who presented with skull base chordomas between Aug.2007 and Oct.2013 were retrospectively reviewed.The skull base defects after endoscopic endonasal resection of the chordomas were classified according to the dimensions of the dural defects as the following：（Type Ⅰ） The dura of skull base was intact after the tumour resection （113 cases） ; （Type Ⅱ） The dural defect was equal or less than 1 cm （12 cases） ; （Type Ⅲ） The dural defect was greater than 1 cm （21 cases）.Three different reconstruction methods were utilized according to the classification of the skull base defects.The reconstruction of the type Ⅰ defect was performed mainly using artificial material; type Ⅱ in a multilayer fashion,mainly using an array of autologous free material including fat,muscle,muscle fascia and artificial material; type Ⅲ using vascular pedicle nasoseptal flap and autologous free material.Results There was no case of postoperative cerebrospinal fluid （CSF） leakage occurred following the reconstruction of type Ⅰ.One case of postoperative CSF leak （8.3%） occurred following the reconstruction of type Ⅱ and two （9.5%） occurred following the reconstruction of type Ⅲ.The rate of postoperative CSF leakage of all the cases is 2.1%.Conclusions Different reconstruction methods should be chosen according to different types of skull base defects.Reducing the use of vascular pedicle nasoseptal flap as much as possible could minimize the trauma of nasal cavity,increase the degree of comfort of the patients and offer convenience for the next skull base reconstruction after the resection of recurrent chordomas.
出处
《中华神经外科杂志》
CSCD
北大核心
2014年第10期1027-1030,共4页
Chinese Journal of Neurosurgery
基金
基金项目：首都卫生发展科研专项（首发2011-1015-06）
北京市卫生系统高层次卫生技术人才队伍建设工程学科骨干培养计划（2011-3-035）
关键词
脊索瘤
神经内镜
颅底重建
Chordoma
Endoscopic
Skull base reconstruction
