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目的经颅-鼻腔双重入路,一期整块切除颅鼻眶肿瘤,应用颅骨外板及帽状腱膜骨膜瓣一期修复前颅底巨大缺损。方法16例颅鼻眶恶性肿瘤,采用经颅-鼻腔双重入路方法一期整块切除肿瘤。术中行双额冠状瓣开颅、骨瓣形成、经前颅窝底探查肿瘤侵犯部位及程度,一期整块切除前颅底及筛窦、眼眶恶性肿瘤。应用鼻腔内窥镜摘除鼻腔内肿瘤。肿瘤切除后,采用颅骨外板、钛板和带蒂帽状腱膜骨膜瓣或双侧颞肌筋膜瓣修复前颅底巨大缺损。结果肿瘤整块切除,术后复发率低。术中一期修补巨大缺损,术后无脑脊液漏及脑膨出等并发症发生。结论经颅-鼻腔双重入路一期切除颅鼻眶恶性肿瘤,手术入路方便,肿瘤切除彻底。应用颅骨外板、钛板及带蒂帽状腱膜骨膜瓣可一期修补肿瘤切除后巨大缺损,修复效果安全可靠,能有效防止前颅底手术后并发症。
Objective To transcranial-nasal dual approach, a one-piece resection of cranial orbital tumors, the application of skull plate and aponeurosis periosteum flap a repair of anterior skull base defect. Methods Sixteen cases of nasal orbital malignant tumors were treated by transcranial-nasal double-entry method to remove the tumor. During the operation, double-crowned coronary valve was used for craniotomy and bone flap formation. The site and degree of tumor invasion were explored through the anterior cranial fossa, and an anterior cranial base and ethmoid sinus or orbital malignancy were excised. Application of nasal endoscopic nasal tumor removal. After tumor resection, skull plate, titanium plate and pedicled aponeurosis flap or bilateral temporal fascia flap repair of anterior skull base defect. The results of tumor resection, postoperative recurrence rate is low. A huge intraoperative amending defects, no postoperative cerebrospinal fluid leakage and encephalocele and other complications. Conclusions The transcranial-nasal double incision resection of nasal orbital malignancy, surgical access convenient, complete tumor resection. The application of skull plate, titanium plate and pedicled aponeurosis flap pedicled peritoneal repair of a huge defect after tumor resection, the repair effect is safe and reliable, can effectively prevent the post-skull base surgery complications.