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目的探讨手术切除侵犯海绵窦的颅底肿瘤的指征及手术要点。方法自1998年11月至2002年5月,中日友好医院神经外科与中国医学科学院肿瘤医院头颈外科合作,连续切除侵犯海绵窦的颅底肿瘤32例,其中鼻咽纤维血管瘤7例,脊索瘤5例,鼻咽癌和鼻咽囊腺癌5例,副鼻窦癌5例,神经鞘瘤3例,嗅神经母细胞瘤1例,颞下翼腭窝低分化癌2例,颞下翼腭窝肉瘤3例,恶性纤维组织细胞瘤1例。23例曾经1次或多次手术切除后复发。对临床资料进行回顾性总结。结果根据肿瘤主体的部位分别选用经上颌骨入路、颞下耳前入路、或额眶入路。全部病例术中显露满意,肿瘤均得到肉眼切除,受累的颅神经一并切除,无手术死亡,术后无偏瘫等严重并发症。术后辅以放射治疗。随访3-50个月,平均19个月,失访3例,4例术后3-6个月死亡,4例带瘤生存,21例健在。结论由下向上侵犯海绵窦的颅底肿瘤可以手术切除,近期效果满意。对颅底正常和病理性解剖结构的熟练掌握以及多学科医生的密切协作是手术取得成功的关键。
Objective To investigate the indications and operative points of surgically excising the skull base tumors infringing the cavernous sinus. Methods From November 1998 to May 2002, 32 patients with cranial base tumors involving the cavernous sinus were consecutively excised from the Department of Neurosurgery, Sino-Japanese Friendship Hospital, and the Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences. Among them, 7 were nasopharyngeal hemangiomas, 5 cases of tumor, 5 cases of nasopharyngeal and nasopharyngeal cystadenocarcinoma, 5 cases of paranasal sinuses, 3 cases of schwannoma, 1 case of olfactory neuroblastoma, 2 cases of inferior paracancer of inferior temporal fossa, 2 cases of inferior temporal fossa 3 cases of palatal sarcoma, 1 case of malignant fibrous histiocytoma. 23 cases had one or more recurrences after resection. The clinical data were retrospectively summarized. Results According to the location of the main tumor were selected by the maxillary approach, infratemporal anterior approach, or frontal orbital approach. All patients showed satisfactory operation, the tumors were macroscopic resection, involving the removal of cranial nerves, no operative death, postoperative hemiplegia and other serious complications. Postoperative radiotherapy. All the patients were followed up for 3-50 months, with an average of 19 months. Three patients were lost to follow-up. Four patients died within 3-6 months after operation. Four patients survived with tumor and 21 patients survived. Conclusions The skull base tumor with inferior cavernous sinus infiltrating upwards can be surgically removed, with satisfactory results in the near future. The mastery of the normal and pathological anatomy of the skull and the close collaboration of multidisciplinary doctors are the keys to successful surgeries.