CAJ | 학술논문

目的探讨前中颅底沟通瘤的临床分类方法及手术治疗,提高临床治疗水平. 方法根据肿瘤主体位置和生长方向将29例前中颅底沟通瘤患者划分为额鼻眶区(16例)、中颅窝一侧颅底区(8例)、颅底中央区-中间颅底区(4例)及岩骨颈静脉孔区(1例)4类,据此并结合病理资料等分别选择扩大经额下人路(13例)、眶上-翼点入路(9例)、额颞眶颧入路(3例)、额颞人路(3例)及岩骨切除入路(1例)进行肿瘤切除和颅底缺损重建,其中采用经鼻内镜等颅内外联合入路11例.结果肿瘤全切除24例.次全切除5例,无手术死亡发生;术后早期出现动眼神经麻痹2例,余未有新的神经功能缺损及脑脊液漏、颅内感染、脑膜脑膨出等严重并发症发生. 结论该分类方法具有界限清楚、部位和范围明确的优点,有利于选择合理手术人路进行肿瘤切除和颅底缺损修复及临床手术治疗效果的提高.
목적 탐토전중로저구통류적림상분류방법 급수술치료,제고림상치료수평. 방법 근거종류주체위치화생장방향장29례전중로저구통류환자화분위액비광구(16례)、중로와일측로저구(8례)、로저중앙구-중간로저구(4례)급암골경정맥공구(1례)4류,거차병결합병리자료등분별선택확대경액하인로(13례)、광상-익점입로(9례)、액섭광권입로(3례)、액섭인로(3례)급암골절제입로(1례)진행종류절제화로저결손중건,기중채용경비내경등로내외연합입로11례.결과 종류전절제24례.차전절제5례,무수술사망발생;술후조기출현동안신경마비2례,여미유신적신경공능결손급뇌척액루、로내감염、뇌막뇌팽출등엄중병발증발생. 결론 해분류방법 구유계한청초、부위화범위명학적우점,유리우선택합리수술인로진행종류절제화로저결손수복급림상수술치료효과적제고.
Objective To study the anatomical classification and surgical management of communicating tumors invading the anterior or middle skull base. Methods According to the location and growth direction of the tumors, the communicating tumors invading the anterior or middle skull base in 29 patients were classified into 4 types, namely fronto-naso-orbital tumors in 16 cases, middle-lateral cranial base tumors in 8 cases, central-medial skull base tumors in 4 cases and petrous bone-jugular foramen tumor in 1 case. Based on this classification, extended transbasal approach (13 cases), supraorbital-pterional approach (9 cases), fronto-temporal approach (3 cases), ffontotemporal-orbitozygomatic approach (3 cases) and transpetrol approach (1 case) were adopted for tumor resection and skull base defect reconstruction. In the transbasal approach group, the surgery was performed also through transnasal endoscopic approaches. Results Twenty-four patients underwent total tumor resection and 5 had subtotal tumor resection. No operative death or serious complications (e.g. intracranial infection, cerebrospinal fluid leakage or meningoencephalocele) occurred after the operations. Conclusion Classification of the communicating tumors invading the anterior or middle skull base according to their location and growth direction facilitates planning of the surgical approaches for tumor resection and skull base defect reconstruction.