To investigate the microsurgical management of cranionasal tumors and the method of the reconstruction of the skull base. Methods From June 2005 to October 2007, 20 patients with cranionasal tumor were treated. There were 10 males and 10 females, aged between 13 and 77 years (median 49 years). The disease course was 2 months to 13 years.The cranionasal tumors, proved by MRI and CT scans, located in the anterior skull base, paranasal sinus, nasal and/or orbit cavity. And their cl inical presentations were l isted as follows: dysosphresia in 14 patients, headache in 11 patients, nasal obstruction in 9 patients, epistaxis in 8 patients, visual disorder in 4 patients, exophthalmos in 4 patients and conscious disturbance in 2 patients. All 20 patients underwent transbasal surgery combined with transnasal surgery, and tumors were resected by one-stage operation. The skull base was reconstructed by surgical technique “Pull Down Sandwich” with pedicle periosteum flap. Results Tumors were resected by one-stage operation, and the anterior skull bases were reconstructed. Pathological examination showed 8 cases of mal ignant tumors and 12 cases of benign tumors. The total surgical excision was complete in 16 patients, and 4 patients with subtotal excision. There was no operative death. Eighteen patients were followed up 3 months to 2 years and 6 months. Transient cerebrospinal fluid rhinorrhea was found in 2 cases which were cured by lumbar drainage. And recurrence of tumor was observed in 5 patients 3 months to 2 years after operation. Conclusion Microsurgical operation via subfrontal approach assisted bytransnasal endoscopy is an effective method in management of cranionasal tumors, with the advantages of econstruction of the skull base with pedicle periosteum flap or “Pull Down Sandwich” and low compl ication rate.
【摘要】 目的 探讨伽玛刀治疗三叉神经痛MRI定位的最佳扫描序列。 方法 选择2004年7月-2006年3月行伽玛刀手术的原发性三叉神经痛患者60例，随机分为3组，每组各20例。伽玛刀术前上头架定位，然后对3组分别采用快速自旋回波序列（Turbo Spin Echo，TSE）、增强三维小角度激发快速梯度回波序列（enhanced three-dimensiunal fast low angle shot，enhanced 3D-FLASH）、三维结构干涉稳态序列（three-dimensional constructive interference in steady state，3D-CISS）进行扫描，观察三叉神经及周围血管的显示情况。 结果 ①TSE扫描20例三叉神经，14例显示优，血管显示一般。②增强3D-FLASH扫描三叉神经，18例显示优，2例显示良，周围血管显示优。③3D-CISS扫描三叉神经，20例均显示优，周围血管显示良。 结论 3D-CISS和增强3D-FLASH序列的融合影像能够清晰地显示三叉神经根及周围血管，有利于伽玛刀的精确定位，具有较高的临床应用价值，可以作为伽玛刀治疗原发性三叉神经痛的常规定位方法。【Abstract】 Objective To evaluate the optimal MRI localization sequences of gamma knife radiosurgery for trigeminal neuralgia. Methods From July 2004 to March 2006, sixty patients with primary trigeminal neuralgia were divided into three groups, using MR Turbo Spin Echo ( TSE), enhanced three-dimensiunal fast low angle shot 3D-FLASH and three-dimensional constructive interference in steady state ( 3D-CISS) sequence for stereotactic localization, respectively. The trigeminal nerve and surrounding vessels were observed. Results Only 14 trigeminal nerves were precisely displayed by MR TSE sequence, while 20 by 3D-CISS and 18 by 3D-FLASH. The display of surrounding vessels was excellent, good, and general by 3D-FLASH, 3D-CISS, and MR TSE, respectively. Conclusion 3D-CISS and enhanced 3D-FLASH fusion image can help achieve accurate orientation of gamma knife, which provides clear images of the trigeminal nerve and the surrounding vessels. Therefore it is of high value in clinical application, which can be used as the conventional localization method for gamma knife radiosurgery in the treatment of primary trigeminal neuralgia.