Surgical Treatment of the Primary Sinonasal Malignancies with Dural and Brain InvolvementстатьяТезисы
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Дата последнего поиска статьи во внешних источниках: 23 ноября 2017 г.
Аннотация:Experience in treatment of 142 patients with primary sinonasal
malignancies with dural and brain involvement in a single
institution was performed. Major types of histological diagnoses
were: adenocystic cancer, adenocarcinoma, low differentiated
carcinoma, sinonasal undifferentiated carcinoma, nasopharyngeal
cancer. Tumor initial sites were nasal cavity, paranasal sinuses and
nasopharynx. These tumors usually destruct anterior skull base and invade dura and brain tissue. TNM distribution of the tumors was
following: T4a (63%) and T4b (37%). Indications for surgery were
developed: the removal of intradural tumor mass, cytoreduction,
histological verification in the absence of pre-biopsy the tumor.
We performed craniofacial resection in 27%, subtotal removal in
25% and biopsy in 48%. The main problems in the surgery planning
were highlighted: resection margins, large skull base defect
reconstruction, general poor condition of the patient because of
the chemotherapy, metastases, respiratory disorders and cachexia.
Preoperative algorithm was described: autologous blood harvesting
(serum and red blood cells), correction of water-electrolyte
and protein metabolic disorders. Complications of craniofacial
resection and subtotal removal were pointed: nasal CSF leak (16%),
infectious and inflammatory complications (8%), oculomotor
and visual impairment (5%), autograft necrosis (4%), and anemia
(17%). The mortality rate was 2%. Indications and contraindications
for resection of the tumor were developed. Optimal ways of scull
base reconstruction after tumor removal were described. Follow-up
period was 4 years.