外側頭蓋底手術(lateral skull base surgery)施行症例の臨床的検討

概要

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Eight cases were treated by lateral skull base surgery. Three benign tumors (2: paraganglioma, 1 : neurinoma) originated from parapharyngeal space and infiltrated into jugular foramen, and five malignant tumors (3: squamous cell carcinoma, 1 : adenoid cystic carcinoma, 1 : rhabdomyosar coma) involved the skull base. Preoperative magnetic resonance imaging gives information as to whether tumors invaded to cranial bone or not, and also permits deciding surgical procedures. Surgical management of mandibular bone was performed in five cases for complete tumor resection and sufficient surgical view ; hemimandibulectomy was carried out in four malignant cases, who simultaneously underwent radical neck dissection, and one benign case underwent mandiblotomy. Ligation of sigmoid sinus was carried out in four cases (1 ; benign, 3 ; malignant) to control bleeding from large vessels. The skull base was reconstracted with myocutaneous flaps which were fixed by fibrin tissue adhesive. No significant surgical complications were not noted. There were no recurrence of benign tumor during 8-13 years follow up period. Malignant tumors, except one (rhabdomyosarcoma), had no local recurrence during follow up period (4 months-2 years) .We emphasize that the progress in preoperative assessment, as well as in reconstructive surgical techniques, will assure more adequate indication of lateral skull surgery for malignant tumors.