SKULL BASE RECONSTRUCTION AND PEROPERATIVE TREATMENT FOR CRANIO-ORBITAL TUMORS/_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIANG Yan ¹ , LIU Jiagang ¹ , FAN Xuezheng ² , CAI Bowen. ¹

1Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;;
2Department of Neurosurgery, Affiliated Ruikang Hospital, Guangxi University of Chinese Medicine.;

Corresponding author：

Keywords：

Cranio-orbital tumor ,Skull base reconstruction ,Peroperative treatment

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Objective To investigate the peroperative treatment of cranio-orbital tumors and the method of the reconstruction of the skull base. Methods Between April 2008 and April 2011, 35 patients with cranio-orbital tumor were treated. There were 21 males and 14 females, aged 17-73 years (mean, 46.3 years). The first symptoms were orbital pain in 13 cases, hypopsia in 12 cases, exophthalmos or abnormal eye position in 5 cases, headache and dizziness in 2 cases, di plopia in 2
cases, and pulsating eyeball in 1 case. Some of the patients needed resecting the zygomatic arch, supercil iary arch, and orbit roof. The autogenous bone, titanium net, frontal bone periosteum, biogel, and artificial meninges were used to reconstruct the skull base. Results Tumors were resected by one-stage operation, and the anterior skull bases were reconstructed. Postoperative MRI indicated that total removal of tumors was achieved in 30 cases, subtotal in 3 cases, and partial in 2 cases at 3 days. There was no operative death. Cerebrospinal rhinorrhea and infection occurred at 1 week in 1 and 2 cases respectively, and were cured after lumbar drainage and antibiotics. The patients were followed up 6 to 36 months (mean, 18 months). In patients having hypopsia, the visual function was improved in 9 cases at 1 month; in patients having orbital pain, pain rel ief was achieved at 2 weeks after operation; in patients having exophthalmos or abnormal eye position and pulsating eyeball, sympotoms disappeared after operation. In 27 patients with benign tumor, 24 were cured, without recurrence during follow-up; in 8 patients with mal ignant tumor, 6 had recurrence within 18 months and underwent second operation or radiotherapy, 2 relapsed cases died of cerebral hernia and respiratory circulating failure at 24 months after operation. No complication of enophthalmos, pulsating exophthalmos, or collapse of zygomatic region occurred. Conclusion Using the autogenous bone, titanium net, frontal bone periosteum, biogel, and artificial meninges to reconstruct the skull base has rel iable foundation, simple operation, and easy anatomical reconstruction, so it is an effective method after the removal of cranio-orbital tumors; better effectiveness would be
obtained when combining with the peroperative nursing.

Citation： JIANG Yan,LIU Jiagang,FAN Xuezheng,CAI Bowen.. SKULL BASE RECONSTRUCTION AND PEROPERATIVE TREATMENT FOR CRANIO-ORBITAL TUMORS/. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(5): 567-570. doi: Copy

1.	Eppley BL. Craniofacial with computer generated htr patient matched implants use in primary bone tumor excision. J Craniofac Surg, 2002, 13(5): 650-657.
2.	Hanasono MM, Silva A, Skoracki RJ, et al. Skull base reconstruction: an updated approach. Plast Reconstr Surg, 2011, 128(3): 675-686.
3.	Young TK, Hardy TG. Solitary fibrous tumor of the orbit with intracranial involvement. Ophthal Plast Reconstr Surg, 2011, 27(3): e74-76.
4.	房居高, 韩德民, 倪鑫, 等. 颅内外沟通性肿瘤的外科治疗. 中国耳鼻咽喉头颈外科, 2005, 12(11): 701-703.
5.	蔡博文, 周良学, 安惠民, 等. 颅鼻沟通性肿瘤一期联合手术及颅底重建的早期疗效. 中国修复重建外科杂志, 2008, 22(5): 589-592.
6.	Banks CA, Palmer JN, Chiu AG, et al. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg, 2009, 140(6): 826-833.
7.	Gagliardi F, Boari N, Mortini P. Reconstruction techniques in skull base surgery. J Craniofac Surg, 2011, 22(3): 1015-1020.
8.	Ascherman JA, Foo R, Nanda D. Reconstruction of cranial bone defects using a quick-setting hydroxyapatite cement and absorbable plates. J Craniofac Surg, 2008, 19(4): 1131-1135.
9.	Avcu N, Kansu O, Uysal S, et al. Cranio-orbital-temporal neurofibromatosis with cerebral hemiatrophy presenting as an intraoral mass: a case report. J Calif Dent Assoc, 2009, 37(2): 119-121.
10.	Shonka DC Jr, Potash AE, Jameson MJ, et al. Successful reconstruction of scalp and skull defects: Lessons learned from a large series. Laryngoscope, 2011, 121(11): 2305-2312.
11.	Zwahlen RA, Grätz KW, Obwegeser JA. The galea fascia flap in orbital reconstruction: innovative harvest technique. Eur J Surg Oncol, 2006, 32(7): 804-807.
12.	Baujat B, Krastinova-Lolov D, Blumen M, et al. Radiofrequency in the treatment of craniofacial plexiform neurofibromatosis: a pilot study. Plast Reconstr Surg, 2006, 117(4): 1261-1268.
13.	Marmulla R, Hoppe H, Mühling J, et al. New augmented reality concepts for craniofacial surgical procedures. Plast Reconstr Surg, 2005, 115(4): 1124-1128.
14.	Pinheiro-Neto CD, Ramos HF, Peris-Celda M, et al. Study of the nasoseptal flap for endoscopic anterior cranial base reconstruction. Laryngoscope, 2011, 121(12): 2514-2520.
15.	Yazici B, Bilge AD, Yazici Z, et al. Congenital cranio-orbital myofibroma. Ophthal Plast Reconstr Surg, 2011, 27(4): 108-111.
16.	Lee KY, Ang BT, Ng I, et al. Stereotaxy for surgical navigation in orbital surgery. Ophthal Plast Reconstr Surg, 2009, 25(4): 300-302.
17.	Lieger O, Richards R, Liu M, et al. Computer-assisted design and manufacture of implants in the late reconstruction of extensive orbital fractures. Arch Facial Plast Surg, 2010, 12(3): 186-191.
18.	Neovius E, Engstrand T. Craniofacial reconstruction with bone and biomaterials: review over the last 11 years. J Plast Reconstr Aesthet Surg, 2010, 63(10): 1615-1623.
19.	Lübbers HT, Jacobsen C, Könü D, et al. Surgical navigation in cranio-maxillofacial surgery: an evaluation on a child with a cranio-facio-orbital tumour. Br J Oral Maxillofac Surg, 2011, 49(7): 532-537.
20.	Clauser L, Polito J, Mandrioli S, et al. Structural fat grafting in complex reconstructive surgery. J Craniofac Surg, 2008, 19(1): 187-191.
21.	Erb MH, Uzcategui N, See RF, et al. Orbitotemporal neurofibromatosis: classification and treatment. Orbit, 2007, 26(4): 223-228.

1. Eppley BL. Craniofacial with computer generated htr patient matched implants use in primary bone tumor excision. J Craniofac Surg, 2002, 13(5): 650-657.
2. Hanasono MM, Silva A, Skoracki RJ, et al. Skull base reconstruction: an updated approach. Plast Reconstr Surg, 2011, 128(3): 675-686.
3. Young TK, Hardy TG. Solitary fibrous tumor of the orbit with intracranial involvement. Ophthal Plast Reconstr Surg, 2011, 27(3): e74-76.
4. 房居高, 韩德民, 倪鑫, 等. 颅内外沟通性肿瘤的外科治疗. 中国耳鼻咽喉头颈外科, 2005, 12(11): 701-703.
5. 蔡博文, 周良学, 安惠民, 等. 颅鼻沟通性肿瘤一期联合手术及颅底重建的早期疗效. 中国修复重建外科杂志, 2008, 22(5): 589-592.
6. Banks CA, Palmer JN, Chiu AG, et al. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg, 2009, 140(6): 826-833.
7. Gagliardi F, Boari N, Mortini P. Reconstruction techniques in skull base surgery. J Craniofac Surg, 2011, 22(3): 1015-1020.
8. Ascherman JA, Foo R, Nanda D. Reconstruction of cranial bone defects using a quick-setting hydroxyapatite cement and absorbable plates. J Craniofac Surg, 2008, 19(4): 1131-1135.
9. Avcu N, Kansu O, Uysal S, et al. Cranio-orbital-temporal neurofibromatosis with cerebral hemiatrophy presenting as an intraoral mass: a case report. J Calif Dent Assoc, 2009, 37(2): 119-121.
10. Shonka DC Jr, Potash AE, Jameson MJ, et al. Successful reconstruction of scalp and skull defects: Lessons learned from a large series. Laryngoscope, 2011, 121(11): 2305-2312.
11. Zwahlen RA, Grätz KW, Obwegeser JA. The galea fascia flap in orbital reconstruction: innovative harvest technique. Eur J Surg Oncol, 2006, 32(7): 804-807.
12. Baujat B, Krastinova-Lolov D, Blumen M, et al. Radiofrequency in the treatment of craniofacial plexiform neurofibromatosis: a pilot study. Plast Reconstr Surg, 2006, 117(4): 1261-1268.
13. Marmulla R, Hoppe H, Mühling J, et al. New augmented reality concepts for craniofacial surgical procedures. Plast Reconstr Surg, 2005, 115(4): 1124-1128.
14. Pinheiro-Neto CD, Ramos HF, Peris-Celda M, et al. Study of the nasoseptal flap for endoscopic anterior cranial base reconstruction. Laryngoscope, 2011, 121(12): 2514-2520.
15. Yazici B, Bilge AD, Yazici Z, et al. Congenital cranio-orbital myofibroma. Ophthal Plast Reconstr Surg, 2011, 27(4): 108-111.
16. Lee KY, Ang BT, Ng I, et al. Stereotaxy for surgical navigation in orbital surgery. Ophthal Plast Reconstr Surg, 2009, 25(4): 300-302.
17. Lieger O, Richards R, Liu M, et al. Computer-assisted design and manufacture of implants in the late reconstruction of extensive orbital fractures. Arch Facial Plast Surg, 2010, 12(3): 186-191.
18. Neovius E, Engstrand T. Craniofacial reconstruction with bone and biomaterials: review over the last 11 years. J Plast Reconstr Aesthet Surg, 2010, 63(10): 1615-1623.
19. Lübbers HT, Jacobsen C, Könü D, et al. Surgical navigation in cranio-maxillofacial surgery: an evaluation on a child with a cranio-facio-orbital tumour. Br J Oral Maxillofac Surg, 2011, 49(7): 532-537.
20. Clauser L, Polito J, Mandrioli S, et al. Structural fat grafting in complex reconstructive surgery. J Craniofac Surg, 2008, 19(1): 187-191.
21. Erb MH, Uzcategui N, See RF, et al. Orbitotemporal neurofibromatosis: classification and treatment. Orbit, 2007, 26(4): 223-228.

Chinese Journal of Reparative and Reconstructive Surgery

SKULL BASE RECONSTRUCTION AND PEROPERATIVE TREATMENT FOR CRANIO-ORBITAL TUMORS/

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