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目的探讨改良扩大前颅底入路的显微解剖和临床应用效果。方法选用福尔马林固定的成人尸头标本15例,颅骨标本20例进行解剖学观察,并对13例应用该入路切除的颅底中线区肿瘤进行临床分析。结果与标准前颅底入路相比改良扩大前颅底入路的暴露范围明显扩大。通过将鼻骨与眶板一起截除,可保留足够长度的鼻中隔粘膜。术式的暴露范围主要受限于双侧的视神经、颈内动脉、翼管、舌下神经管等结构。本组13例中,9例全切除;1例近全切除;3例大部切除。术后发生并发症5例。无手术死亡。结论改良扩大前颅底入路具有暴露充分、脑损伤小、可有效保护嗅觉等优点。该入路是切除颅底中线部位侵犯眶、鼻、筛、蝶和斜坡肿瘤的较佳入路。
Objective To explore the microsurgical anatomy and clinical application of improved anterior cranial base approach. Methods Fifteen adult cadaver heads fixed in formalin and 20 skull specimens were selected for anatomical observation. Thirteen patients with tumors in the midline of skull base were enrolled in this study. Results Compared with the standard anterior skull approach, the exposure range of the improved anterior skull base approach was significantly enlarged. By truncating the nasal bone with the orbital plate, a sufficient length of nasal septum may be retained. The scope of surgical exposure is mainly limited to bilateral optic nerve, internal carotid artery, wing tube, sublingual tube and other structures. In this group of 13 cases, 9 cases of total resection; 1 case near total resection; 3 cases of most resection. Postoperative complications occurred in 5 cases. No surgery died. Conclusion The improved anterior skull base approach has the advantages of adequate exposure, less brain injury, and better protection of sense of smell. The approach is to remove the midline part of the skull base invasion of orbital, nasal, sieve, butterflies and slopes of the better access.