摘要
目的研究扩大经鼻入路内镜切除前颅底巨大脑膜瘤的手术效果,以及不同颅底重建的方法和可行性。方法回顾性分析18例行扩大经鼻内镜手术治疗的前颅底巨大肿瘤患者的临床资料。患者肿瘤侵犯前颅底骨质范围的长径均>4 cm。切除肿瘤后,14例患者采用生物膜、人工骨基质和带蒂鼻中隔黏膜瓣进行颅底多层修复,4例患者用阔筋膜辅助进行颅底重建。结果肿瘤完全切除者17例,少许残留者1例;术后住院平均时间为8.5 d。术后腰大池置管引流3例,发生颅内感染和脑脊液鼻漏患者1例。所有患者均无迟发型脑膜脑膨出、颅底重建组织坏死或塌陷。结论扩大经鼻内镜切除前颅底巨大脑膜瘤切实可行。颅底重建依照缺损的位置、大小及病变侵袭的范围,选择不同的修补方式;带蒂鼻中隔黏膜瓣修补前颅底可以实现,且临床证实是安全、有效的,阔筋膜和带蒂额部骨膜瓣在鼻中隔黏膜瓣不能完全覆盖时是一种可靠的选择。
Objective To review experience with endoscopic endonasal approach(EEA)for anterior skull base meningioma,and to explore the feasibility of different methods of skull base reconstruction.Methods The clinical data of 18 patients with anterior skull base meningioma resected by EEA were analyzed retrospectively.The diameter of tumor invading the bone of anterior skull base were>4 cm.The tumor was resected by EEA.After the operation,14 cases were repaired with biomembrane,artificial bone matrix and pedicled nasal septum mucosa flap,and part of them were assisted by fascia lata(4 cases).The surgical effect and the effectiveness of different skull base reconstruction methods were summarized.Results 17 cases were completely resected and 1 case was a little residual.The average postoperative hospital stay was 8.5 days.There were 3 cases with lumbar cistern drainage,1 case of intracranial infection and cerebrospinal fluid rhinorrhea.There was no delayed meningoencephalocele,necrosis or collapse of skull base reconstruction tissue in all patients.Conclusions Extended transnasal endoscopic resection of giant meningioma in anterior skull base is feasible.According to the location and size of the defect and the extent of invasion of the lesion,different repair methods are selected.The pedicled nasal septum mucosal flap can repair the anterior skull base,and it is safe and effective clinically.The fascia lata and pedicled frontal periosteal flap are reliable choices when the nasal septal mucosal flap can not be completely covered.
作者
周跃飞
伊西才
赵全成
贾鹏飞
刘卫平
高大宽
ZHOU Yue-fei;YI Xi-cai;ZHAO Quan-cheng(Department of Neurosurgery, Xijing Hospital, Airforce Medical University, Xi'an 710032, China)
出处
《临床神经外科杂志》
CAS
2020年第6期611-615,620,共6页
Journal of Clinical Neurosurgery
关键词
内镜经鼻入路
前颅底脑膜瘤
带蒂鼻中隔黏膜瓣
脑脊液鼻漏
颅底重建
endoscopic endonasal approach
anterior skull base meningioma
pedicled nasoseptal flap
cerebrospinal fluid rhinorrhea
skull base reconstruction
作者简介
通讯作者:高大宽;通讯作者:刘卫平。
