根治性切除占据中央颅底多个区室的复杂病变仍然是一个重大挑战,因为暴露不足和不适当的技术可能会损害手术结果。然而,上颌摆动入路对这些病变的有效性尚未得到充分评估。选择适当的手术时,必须仔细评估病变特征。
在2006年5月至2017年2月之间,17例患者使用上颌摆动入路切除了中央颅底的广泛病变。如代表性案例所示,我们回顾了有关临床发现和技术考虑的数据.
在所有患者中实现了完全切除。病理结果多种多样,大多数是神经鞘瘤(9例,52.94%),其次是脑膜瘤(世界卫生组织II)(3例,17.65%)。并发症如案例插图所述进行处理,症状随时间改善。随访时间为62至192个月(中位数,114个月),而2例患者失访。没有观察到死亡。由于无症状状态,两名恶性肿瘤复发的患者仍在观察中。
我们的初步结果表明,上颌摆动法可以作为处理极端病例的另一种选择,例如大,广泛的,具有纤维性或钙化性的高血管化肿块,或中央颅底复发性病变。可以成功获得整体切除,导致长期的本地控制。
Radical resection of complex lesions occupying multiple compartments at the central skull base remains a significant challenge, since surgical outcomes may be compromised by insufficient exposure and inappropriate techniques. However, the efficiency of the maxillary swing approach for these lesions has not been sufficiently evaluated. Careful assessment of lesion characteristics must be performed when selecting the appropriate procedure.
Between May 2006 and February 2017, 17 patients underwent resection of extensive lesions in the central skull base using the maxillary swing approach. As shown in the representative cases, data regarding clinical findings and technical considerations were reviewed.
Complete resection was achieved in all patients. The pathological findings were diverse, and the majority were schwannomas (9 cases, 52.94%), followed by meningiomas (World Health Organization II) (3 cases, 17.65%). Complications were managed as described in the case illustrations, and symptoms improved with time. The follow-up duration ranged from 62 to 192 months (median, 114 months), while 2 patients were lost to the follow-up. No mortality was observed. Two patients who experienced malignancy relapse were still under observation due to their asymptomatic status.
Our preliminary results suggest that the maxillary swing approach can be an alternative option for managing extreme cases, such as large, extensive, hypervascularized masses with fibrous or calcified consistency, or for recurrent lesions in the central skull base. En bloc resection can be successfully obtained, resulting in long-term local control.