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目的探讨内镜经鼻入路颅底手术后使用钛网行前颅底重建的可行性。方法 2006年4月至2007年1月,选择8例内镜经鼻颅底手术后颅底骨质缺损的患者,术中尝试内镜下经鼻入路使用钛网行前颅底重建。将钛网剪成双排网眼约3.0 cm×2.0 cm 的条状,采用内镜引导下经鼻植入前颅底,依次由前向后使其横行嵌入双侧眶上壁与前颅底硬脑膜间,以修复前颅底骨质缺损。结果8例患者中前颅底骨质缺损2例,前颅底及蝶鞍骨质缺损2例,前颅底、蝶鞍及斜坡骨质均缺损4例。组织病理学类型:嗅神经母细胞瘤2例,鳞状细胞癌1例,软骨肉瘤1例,恶性纤维组织细胞瘤1例,脑膜瘤2例,脊索瘤1例。术后随访2～10个月,1例钛网移位于鼻腔,其余7例均未发生移位,且鼻腔侧有黏膜覆盖。结论内镜经鼻入路使用钛网行前颅底重建方法简便、安全、可行,并能够获得满意的重建效果。
Objective To investigate the feasibility of endoscopic skull base reconstruction using titanium mesh in skull base surgery. Methods From April 2006 to January 2007, 8 patients with skull base defect after endoscopic naso-skull base surgery were enrolled in this study. The titanium mesh cut into double-row mesh about 3.0 cm × 2.0 cm strip, guided by endoscopic nasal transoesophageal anterior skull base, followed by the front to the transverse embedding of the lateral orbital wall and the anterior skull base hard Meningeal, to repair the anterior skull base defect. Results In 8 cases, there were 2 cases of anterior skull base defect, 2 cases of anterior skull base and sella defect, and 4 cases of anterior skull base, sella and slopes. Histopathological types: olfactory neuroblastoma in 2 cases, squamous cell carcinoma in 1 case, chondrosarcoma in 1 case, malignant fibrous histiocytoma in 1 case, meningioma in 2 cases and chordoma in 1 case. The patients were followed up for 2 to 10 months. One case of titanium mesh shifted to the nasal cavity, and the other seven cases did not have any displacement. The mucosa was covered on the side of nasal cavity. Conclusion Endoscopic transnasal approach using titanium mesh anterior skull base reconstruction is simple, safe and feasible, and can obtain satisfactory reconstruction results.