RESUMEN
From 1997 to 2004, the Academician N. N. Burdenko Research Institute of Neurosurgery has operated on 54 patients with intracranial meningiomas spreading into the infratemporal fossa. Fifteen patients were operated on for the first time. Thirty-nine patients had undergone surgical interventions on the average 3 times (from 2 to 8). All the patients were operated on via different orbitozygomatic approaches depending on the extent of the process. Opening the upper and lower palpebral fissures and the round foramen with resection, if required, the pterygoid processes suffice to remove tumors from the areas of the upper and lower palpebral fissures, which spread into the sphenoid and maxillary sinuses. If there are tumors at the site of the base of the anterior surface of the pyramid, and the articular bursa, it is expedient to open the oval and spinous foramens, to resect the external portions of the fundus of the middle cranial fossa and, if required, the articular process of the lower jaw. By taking into account the X-ray and histological patterns, it may be stated that invasion of meningiomas is not always accompanied by the development of hyperostosis. According to our findings, extracranial growth of meningiomas points to the invasion of osseous structures of the middle cranial fossa. Furthermore, if meningiomas grow into the infratemporal fossa, they frequently involve the muscles, nerves, and mucosa. After removing the tumors spreading to the infratemporal fossa, the optimum plastic repairs of defects of the base of the skull are as follows: hermetic closure of basal defect of the dura mater with a free fat flap, by fixing it with sutures and fibrin-thrombin glue with additional plastic repair of skull base defect with local displaced tissues on a pedicle (with a temporal muscular fascioperiosteal flap, a Bisch fat flap). Further policy of management of these patients is a complicated problem. It depends on the radicalism of an operation and the invasiveness of the process. The histobiological features of infiltrative meningiomas should be studied and this will determine management policy. Conceivably, the use of postoperative radiation therapy will be substantiated in a definite group of patients.
Asunto(s)
Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/cirugía , Meningioma/diagnóstico , Meningioma/cirugía , Neoplasias de la Base del Cráneo/diagnóstico , Neoplasias de la Base del Cráneo/cirugía , Angiografía Cerebral/métodos , Femenino , Estudios de Seguimiento , Cefalea/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/patología , Meningioma/patología , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Base del Cráneo/patología , Neoplasias de la Base del Cráneo/patología , Colgajos QuirúrgicosRESUMEN
The paper analyzes surgical techniques for removal of hyperostotic cranial orbital meningiomas in 36 patients operated on in 1998 to 2000. In 19 cases hyperostosis extends to the upper and lower lid slits without involving the optic canal. It also spreads to the ethmoidal sinus in 6 cases to the frontal sinus in 3, and to the maxillary one in 2 patients. In 3 patients, hyperostosis was beyond the wing of the basic bone, by involving the temporal and frontal squamous. In 19 cases, hyperostosis was resected and the tumor was removed without creating any additional bone flaps. To make an additional basal bone flap can provide a much wider access by reducing the traction of both orbital and cerebral tissues. An orbitozygomatic flap was formed in 16 cases. To create a lateral orbital flap was sufficient to effectively eliminate hyperostosis in 3 patients. Impaired postoperative visual acuity was observed in 5 patients undergone resection for the hyperostotic optic canal, in 2 patients of them there was a decrease in visual acuity from 1.0 to 0.1 and in 1 patient it reduced from 1.0 to 0.2. A year later, visual acuity in these patients increased up to 0.5-0.8. After resection of the hyperostotic optic canal, blindness occurred in 2 patients, in one of them, photoperception appeared on day 5 after surgery and 3 months later visual acuity restored up to 0.6. Thus, the use of high-speed drill and the creation of an orbital or orbitozygomatic flap can increase the efficiency of removal of hyperostotic cranial orbital meningiomas.
Asunto(s)
Meningioma/cirugía , Neoplasias Orbitales/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Meningioma/fisiopatología , Persona de Mediana Edad , Neoplasias Orbitales/fisiopatología , Agudeza VisualRESUMEN
Chondrosarcomas are malignant mesenchymal tumors of chondroid nature. Less than 5% of all chondrosarcomas are localized in the head and neck. The paper analyzes a case of extensive chondrosarcoma of the skill base, which involves the anterior and median cranial fossa, ethmoidal, sphenoidal, right maxillary sinuses, and intratemporal fossa. A basal approach that is a combination of two-flapped subfrontal and orbitozygomatous accesses was used to remove the tumor. In doing so, the tumor could be excised and extensive defects of the skull base could be effectively closed with the flaps of the periostium and musculus temporalis, yielding a good functional and cosmetic effect.