【摘要】 目的　探讨鼻颅沟通瘤的手术治疗方法,以选择最佳的手术入路。方法　上颌、鼻转位合并额或颞下入路11例,其中鳞状细胞癌8例,乳头状癌2例及脑膜瘤1例;颅面联合入路5例, 4例为鳞状细胞癌, 1例为恶性嗅神经上皮瘤;鼻锥额骨转位切除1例为鼻颅沟通脑膜瘤。结果17例患者中, 2例脑膜瘤患者中的1例脑膜瘤累及海绵窦的部分肿瘤未能切除,另1例完整切除术后7年无复发迹象;15例恶性肿瘤患者,经上颌鼻锥转位合并额或颞下入路10例,术后1年余死亡1例,存活3年以上7, 5年以上5例;颅面联合入路5例,术后6个月余死亡1例,术后存活3年以上4例, 5年以上2例。全部病例术后伤口均一期愈合。结论　上颌鼻锥转位合并额或颞下入路是切除鼻颅沟通瘤的最佳入,鼻锥额窦前骨壁转位适于切除额窦发育良好颅内侵犯较局限的鼻颅沟通瘤,颅面联合入路适于面骨被累的鼻颅沟通瘤。更多还原

【Abstract】 Objective To investigate the surgical approaches for sinonasal tumors with intracranial extension. Methods Seventeen patients with intracranial invasion tumors were treated surgically by maxillectomy combined with frontal or infratemporal approaches in 11 cases, including squamous cell carcinoma 8 cases, papillocarcinoma 2 cases and meningioma 1 case. Nasofrontal bone translocation in 1 case which was a meningioma case, craniofacial approaches in 5 cases, including squamous cell carcinoma 4 cases and esthesioneuroblastoma 1 csae. Results One of two meningnioma cases with cavernous sinus invasion was incompletely resected, another case was resected en bloc. In malignant group, ten cases were treated by nasomaxillectomy combined with frontal or infratemporal approaches. One patient died 1 year after operation, 7 cases survived for over 3 years, and 5 for over 5 years. Five cases were treated by craniofacial approach, among them, one patient died 6 months after operation, 4 cases survived for over 3 years, and 2 for over 5 years. All patients healed smoothly. Conclusions Maxillary nasopyramid translocation combined with frontocranial or infratemporal approach is available for en bloc removal of sinonasal tumors with intracranial extension. The nasofrontal bone translocation is available for removal of tumors with limited intracranial extension and well developed frontal sinus. Cranioanterolateral facial approach is suitable for nasocranial tumors with facial bone involvement.更多还原