前颅底缺损硬脑膜重建的长期临床随访
Long-term follow-up results of dural reconstruction without bone graft at anterior skull-base defects
目的观察前颅底骨缺损是否必须重建.方法随访50例病人前颅底缺损只重建硬脑膜不行骨移植,术后定期临床随访及CT、MRI检查.结果前颅底骨缺损范围为:前后径2-6cm(平均3.5cm),左右径2-5cm(平均2.8cm).按骨缺损左右径分:2-3cm者为38例,3-4cm为10例,4-5cm为2例.随访时间为3个月至5年(平均2年).结论手术中只要将颅底硬脑膜妥善修复,再辅以带蒂颅骨膜瓣加强颅底重建,术后颅内压不高,在通常的颅底骨缺损范围内(缺损直径不超过4cm),一般不会发生脑膜脑疝出,不必行颅底骨移植.
更多Objective To clarify whether it is necessary to reconstruct bone defects at the anterior skull base.Methods A long-term follow-up study of 50 patients with anterior skull-base defects in which the dura was reconstructed without bone grafts was conducted. CT and MRI examinations were taken periodically after surgery.Results The ordinates of the bone defects averaged 3.5cm (range, 2-6cm), and the abscissas averaged 2.8cm (range, 2-5cm). The abscissas of the bone defects measured 2-3cm in 38 patients, 3-4cm in 10 patients, and 4-5cm in 2 patients. The follow-up ranged from 3 months to 5 years (average, 2 years).Conclusions At normal intracranial pressure, if the dura mater is repaired properly at the skull-base defects and reinforced with a pedicled pericranial flap, encephalomeningocele and cerebrospinal fluid (CSF) leakage can be prevented. It may not be necessary to make free bone grafts when the size of the cranial base bone defect is smaller than 4cm.
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