GUIDELINE FOR PRESERVING ORBITAL CONTENTS IN SKULL BASE SURGERY FOR NASAL/PARANASAL SINUS MALIGNANCIES
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概要
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It would help patient's quality of life if they were given an appropriate guideline for preserving orbital contents in skull base surgery for nasal/paranasal sinus malignancies.We have hnd 60 patients that received skull base surgery for nasal/paranasal sinus malignancies at Shizuoka Red Cross Hospital in the last 10 years. Orbital contents could be preserved in 20 of these cases, in which is were anterior, five were middle, and none was anterior-middle skull base resection. There was no local recurrence for more than two years after skull base surgery in all of the patients with preserved orbital contents.Intracranial dissemination could be seen in a case of malignant melanoma at eight months after the anterior skull base surgery, and local recurrences in the nasal cavity occurred at four months in one case of adenocarcinoma, which had no recurrences in the orbit after the anterior skull base surgery.There were mild double vision and/or enophthalmos in small patients as postoperative complications.Considerable sites of orbital exenteration were periorbita, orbital fat, ocular muscles, muscle cone, optic canal, anterior clinoid process, eyelid, and/or lacrimal sac, in connection with resection of the anterior skull base. Among these sites, periorbita and orbital fat were the site that orbital contents could be preserved if the tumor localized at there, and they might be preserved in the cases that the tumor invaded in one of ocular muscles, the inferior eyelid, or the lacrimal sac. On the other hand, the important areas for orbital exenteration were the superior orbital fissure, the C3 portion of ICA, and/or the cavernous sinus in relation to resection of the middle skull base combined with the maxilla. When the tumor was localized at the lateral part of the greater wing of the sphenoid bone, they also could be preserved. But, they should be resected in cases with malignant melanoma or other histologically severe malignancies to achieve such a higher recurrence rate.
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日本頭頸部癌学会 | 論文
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