經顱切除鼻腔及副鼻竇腫瘤－手術技巧及結果

背景：自1954年Smith等首次發表以顱顏切除術(craniofacial resection)切除侵犯顱底之副鼻竇腫瘤以來，顱顏切除術已成為治療涉及前顱底(anterior skull base)腫瘤的標準術式。本研究之目的，在於探討經由慎選病患，以單純的經顱切除術(transcranial resection)治療涉及前顱底之鼻腔及副鼻竇腫瘤，並就其結果加以分析。方法：本報告收集自1993年12月至2002年7月間，於本科接受單純經顱切除涉及前顱底的鼻腔及副鼻竇腫瘤病患共8例（惡性腫瘤6例，良性腫瘤2例），作為回溯性研究分析的對象。結果：在這8名病例中，並沒有病患因手術而死亡，只有2名病患產生併發症。預後方面，除了一例在術後10個月因腫瘤擴散死亡之外，其餘患者定期於門診追蹤並無復發跡象。結論：現今顱顏切除術乃是治療涉及前顱底腫瘤的標準術式，然而在詳細的術前評估以及謹慎選擇病患的前提之下，以單純經顱切除術治療涉及前顱底之鼻腔及副鼻竇腫瘤亦為一可行的方法。

關鍵字

經顱切除術；腫瘤；鼻腔；副鼻竇；顱底

並列摘要

BACKGROUND: The craniofacial resection is standard procedure in the management of tumors involving the anterior skull base. It provides a bi-directional approach, a wide surgical field, and facilitates oncologically sound resection. The transcranial approach alone can provide excellent exposure, enables the use of a galeopericranial flap for skull base reconstruction and avoids facial incisions. The aim of this study is to evaluate the outcome of carefully selected patients who underwent transcranial resection of sinonasal tumors involving the anterior skull base. METHODS: Between December 1993 and July 2002, eight patients (including 6 with malignant tumors and 2 with benign tumors) who underwent transcranial resection for nasal cavity and paranasal sinus tumors that involved the skull base were enrolled in this study. RESULTS: There was no surgical mortality. Only two complications were encountered. One patient died of cancer dissemination and the others remained free of tumor in regular follow-up. CONCLUSION: The transcranial approach alone may provide adequate exposure to facilitate oncologically sound resection of nasal and paranasal tumors that involve the anterior cranial base. It has the advantage of providing galeopericranial flaps to reconstruct skull base defects and also avoids facial scarring. In selected patients, the transcranial approach is a reasonable alternative approach.

並列關鍵字

transcranial resection ； tumor ； nasal cavity ； paranasal sinus ； skull base

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經顱切除鼻腔及副鼻竇腫瘤－手術技巧及結果

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