頭蓋底チーム医療における形成外科的アプローチと再建の工夫

概要

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According to the recent advance in aggressive excision of skill base tumor, the more sofisticated primary reconstruction has been developed with a craniofacial techniques for preservation of post-operative quality of life. We have organized skull base surgery team with otolaryingologists, neurosurgeons and plastic surgeons in Kansai Medical University Hospital since 1993 and managed over 50 cases of skull base malignancies. The cases are preoperatively evaluated with our classification of the surgical resection types (1993) in the skull base OPD and decided on the approach and the procedure of resection and repair. We, as a plastic surgeon, have developed several methods for the access and procedures for the reconstruction: “hemifacial dismasking approach” (1993) for an extensive resection of type C with or without a carotid canal dissection, “trans Le Fort I with maxillar splitting approach” (1993) for a widely in vasive clivus tumor, “two-way approach” (1997) for a one-box hallow-out resection for a limited ethmo-basal tumor of type A resection, “flying buttress” technique for an orbitofacial reconstruction with composite free tissue transfer (1996) for a extensive defect after type C resection. The procedures are mentioned, illustrating the representative cases of a series of past 7 years.