颅前窝底骨质缺损无骨性重建的临床观察

目的探讨颅底肿瘤术后大范围骨性缺损行骨性重建的必要性。方法回顾性分析45例颅前窝底肿瘤伴大范围骨质破坏病人的临床资料,均行肿瘤切除;其未行骨性重建(观察组)30例,行骨性重建加软组织重建(对照组)15例。并对比两组疗效及并发症的发生率。结果两组均无围手术期死亡病例。术后早期并发症5例,其中观察组脑脊液鼻漏1例,脑脊液鼻漏合并脑膜炎及脑积水2例;对照组钛网从鼻腔脱出1例,移植钛网产生排斥反应1例,均未发生脑脊液鼻漏。随访6～99个月,肿瘤复发5例,其中死亡4例,带瘤生存1例;两组均无迟发性脑脊液鼻漏、脑组织下沉、脑膜脑膨出、空蝶鞍综合征等并发症。两组并发症的发生率经检验差异无统计学意义(P0.05)。结论颅底肿瘤切除术后的颅前窝底骨质缺损没有必要一定重建其骨性结构,仅行软组织重建即可获得满意的效果。

Clinical observation of non-osseous reconstruction for bony defects of anterior cranial fossa

Objective To investigate the necessity of osseous reconstruction for large-scale bony defects after skull base tumor resection.Methods Clinical data of 45 patients with skull base tumor companied by large-scale bony defects was analyzed retrospectively.After tumor resection,the patients were divided into two groups：observation group（30 patients） treated with non-osseous reconstruction and control group（15 patients） treated with reconstruction of bone and soft tissue.The complication rate was compared in both groups.Results No patients died in the perioperative period.Early postoperative complications included cerebrospinal fluid rhinorrhea（CSFR） in 1 case and CSFR companied by meningitis and hydrocephalus in 2 cases in observation group,while titanium mesh taken off from nostril in 1 case and titanium mesh caused rejection in 1,but no CSFR in control group.During a follow-up period ranged from 6 to 99 months,4 patients died and 1 lived with tumor in 5 cases of recurrence.There were no delayed complications such as delayed CSFR,brain tissue sinking,encephalomeningocele and empty sella syndrome in both groups,and there was no significant difference in complication rate between the two groups.Conclusions It is not necessary to perform osseous reconstruction after skull base tumor resections in every case,just soft tissue reconstruction can achieve satisfactory outcome.