前中颅底异物伤的治疗策略  

Neurosurgical treatment strategy of foreign body injury in anterior-middle skull base

作　　者：刘浩成[1] 王卫[1] 孙博文 徐勇[1] 李永[1] 康军[1] 张天明[1] 周军[2] 史翔宇[2] 张家亮[1] Liu Haocheng;Wang Wei;Sun Bowen;Xu Yong;Li Yong;Kang Jun;Zhang Tianming;Zhou Jun;Shi Xiangyu;Zhang Jialiang(Department of Neurosurgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院神经外科,100730 [2]首都医科大学附属北京同仁医院眼科,100730

出　　处：《中华神经外科杂志》2018年第8期824-829,共6页Chinese Journal of Neurosurgery

摘　　要：目的 初步探讨针对前中颅底异物伤的治疗策略.方法 回顾性分析2003年1月至2017年12月首都医科大学附属北京同仁医院神经外科收治的68例前中颅底异物伤患者的临床资料.39例行开颅异物取出术,18例行经鼻内镜颅底入路异物取出术,11例采用异物直接拔除.3例行血管内治疗.结果 65例顺利取出异物,3例有部分异物残留.随访时间为3个月至3年,中位时间为7个月.1例术后出现眼睑伤口感染,3例出现一过性颅内感染,2例发生脑脊液漏,2例发生颅内出血.无一例死亡.术前失明或视力下降的53例患者中,视力改善34例（64.2％）;存在眼动障碍的35例患者中,部分恢复19例（54.3％）;术前存在面部感觉减退的5例患者术后未见明显缓解;3例偏瘫患者中,2例肢体肌力有改善.结论 根据颅底异物伤的性质和部位,遵循前中颅底异物伤的临床治疗路径,采用相应的治疗策略,在提高患者的救治成功率、降低致残率以及病死率方面可初见成效.Objective To investigate the neurosurgical treatment strategies of the foreign body injury in anterior-middle skull base.Methods Clinical data of 68 cases with foreign body injuries in anterior-middle skull base admitted to Department of Neurosurgery,Beijing Tongren Hospital,Capital Medical University from January 2003 to December 2017 were retrospectively analyzed.The foreign bodies were removed by craniotomy in 39 cases,by endoscopic skull base surgery in 18 cases,and were pulled out directly in 11 cases.Three cases underwent endovascular treatments.Results Foreign bodies were completely removed in 65 cases and partially removed in 3 cases.Follow-up period ranged from 3 months to 3 years with the median duration of 7 months.Eye-lid infection occurred in 1 case,transient intracranial infection in 3 cases,cerebrospinal fluid leakage in 2 cases,and intracranial hemorrhage in 2 cases.No death occurred in this group.Of 53 cases with preoperative visual defect,34 （64.2％） had visual improvement.Of 35 cases with eye movement defect,19 （54.3％） partially recovered.Five cases with facial numbness had no recovery.Of 3 cases with paralysis,2 had improvement.Conclusion Good outcome and low disability rate and mortality could be achieved by surgical treatment with various strategies designed based on the characteristics and locations of skull base foreign bodies.

关 键 词：颅脑创伤 神经外科手术 异物 颅底 内镜 

分 类 号：R651.15[医药卫生—外科学]