Surgical approaches to the skull base neoplasms / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the best surgical approach to the skull base neoplasms.</p><p><b>METHODS</b>Retrospective analysis the 79 skull base neoplasms cases treated with surgical resection in Qilu hospital of Shandong university from 1992 to 2002. Eleven surgical approaches including midfacial degloving, frontal coronal discission, nasal eversion, maxillary swing, partial maxillary resection, total resection of orbit, mandibular swing, combination of front, temple, preauricular, post aureum, neck, and transoral approaches were used to resect the tumor which involved fossae pterygopalatine, paranasal sinuses, nasopharynx, antero, meso and posterobasilar region, lobi frontalis and lobi temporalis of cerebrum.</p><p><b>RESULTS</b>Seventy-nine skull base neoplasms were totally removed and no one died from the operation. Although 5 cases complicated with cerebrospinal fluid leak and all recovered within 1 week, no serious cranium-cerebrum complication occurred. In 29 patients with benign tumor including 11 cases of meningioma, 3 cases of chondroma, 1 case of hemangio-meningioma, 1 case of cavernous hemangioma, 2 cases of osteodysplasia fibromas, 9 cases of neurofibroma, 1 case of glomus jugular tumor, 1 case of neurilemmoma, 19 have survived over 5 years and the longest one has survived over 8 years. For 50 patients with malignant tumor including 3 cases of well-differentiated squamous cell carcinoma, 17 cases of moderately differentiated squamous cell carcinoma, 11 cases of poorly differentiated squamous cell carcinoma, 1 case of undifferentiated carcinoma, 2 cases of chondrosarcoma, 5 cases of canceration of papilloma, 2 cases of adenocarcinoma, 1 case of esthesioneuroblastoma, 2 cases of malignant fibrohistiocytoma, 1 case of fibrosarcoma, 2 cases of malignant mixed tumour, 3 cases of sarcoma survival rates of 3 and 5 years were 59.2% (29/49), 38.5% (10/26) respectively.</p><p><b>CONCLUSION</b>In order to resect the tumor completely and reduce the complication and malformation as far as possible, different surgical approaches must be designed according to the pathological changes characters and involved area,and the surgeon should select the shortest approach, avoid to damage the important neurovascular structure, and resect the tumor through the natural anatomy space by the shelter incision.</p>

Clinical study of combined approach of tympanoplasty and mastoidectomy with close technique / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To improve the surgery results and living quality of patients following the operation of the combined approach of tympanoplasty and mastoidectomy with close technique.</p><p><b>METHODS</b>The clinical data and following-up results of 49 patients treated with combined approach of tympanoplasty and mastoidectomy with close technique and 82 patients treated with open mastoidectomy with tympanoplasty were retrospective analyzed.</p><p><b>RESULTS</b>In the group treated with combined approach tympanoplasty, all patients got dry ear in 20 days and 31 patients' hearing level enhanced over 15 dB after the operation; but in the group treated with open mastoidectomy with tympanoplasty, only 13 patients got dry ear in 20 days and no patients' hearing level enhance over 15 dB after the operation. Although the recurrence rates between two groups were not significant difference, the patients of former group not only took a shorter recovery time and got a better hearing recovery, but also kept a normal external auditory meatus, at the same time, they need not to clear scab at fixed period all life long.</p><p><b>CONCLUSIONS</b>When performed on carefully selected patients, combined approach tympanoplasty was a feasible surgical method to improve the surgery results and living quality of patients following the operation, however, the advanced equipment and perfect operation skill are necessary.</p>