鼻眶颅沟通性巨大表皮样囊肿1例
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海军军医大学第二附属医院上海长征医院耳鼻咽喉头颈外科

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国家自然科学基金(81670905,81870702),上海长征医院创新型临床研究项目(2020YLCYJ-Y23),上海长征医院金字塔人才工程(0907),装备军内科研项目(HJ20202A020060)


Communicating Giant Epidermoid Cyst of Nasal Orbital Skull Base: A Case Report
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The Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital)

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    目的 总结1例鼻眶颅沟通性巨大表皮样囊肿患者的临床资料,并结合相关文献进行复习,探讨鼻眶颅沟通性表皮样囊肿的治疗方式,以提高临床医师对此病的认识。方法 对收治的1例鼻眶颅沟通性表皮样囊肿患者行肿瘤切除+前颅底重建修复术,术中见肿瘤底壁位于残留的眶后内侧壁,肿瘤后方颅底骨质缺损。完整切除肿瘤后,眶上裂与前颅底交界处见脑脊液漏,遂转带蒂颞肌皮瓣,填塞嵌顿于脑脊液漏骨质缺损处,重建修复前颅底。残留空腔取自体脂肪组织移植填充,恢复正常鼻眶颅底外形。术后组织送病检。结果 术后患者鼻眶外形恢复正常,压迫症状消失,送检组织病理提示为表皮样囊肿。随访至今4年,未见肿瘤复发,患者生活质量改善。结论 鼻眶颅沟通性表皮样囊肿的治疗首选手术切除,对于出现颅底缺损的病例,颅底结构的重建修复是减少术后并发症、提高生存质量的关键。

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    Objective To report a case of communicating giant epidermoid cyst of nasal orbital skull base and the relevant literatures were reviewed in order to investigate the treatment of communicating epidermoid cyst of nasal orbital skull base and improve the clinicians" understanding of the rare disease. Methods One patient with communicating giant epidermoid cyst of nasal orbital skull base was performed with resection of tumor plus reconstruction of anterior skull base. During surgery, the tumor bottom wall was located in the residual medial posterior orbital wall, and the bone defect of the skull base behind the tumor was observed. After complete resection of the tumor, cerebrospinal fluid leakage was found at the junction of the superior orbital fissure and the anterior skull base, so a pedicled temporal musculocutaneous flap was transferred to fill and reconstruct the anterior skull base. The remaining cavity was transplanted adipose tissue to restore the normal shape of the nasal-orbital-skull base. The tumor was sent to the department of pathology for diagnosis. Results The patient"s nasal and orbital appearance returned to normal, and the compression symptoms disappeared after satisfying surgery. Histological examination suggested for epidermoid cyst. There was no recurrence during 4 years follow-up. Conclusion Surgical resection is the first choice in treatment of the communicating giant epidermoid cyst of nasal orbital skull base. In the case of a cranial base defect, reconstruction and repair of the skull base structure is essential to reduce postoperative complications and improve the quality of life.

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  • 收稿日期:2022-05-08
  • 最后修改日期:2022-07-21
  • 录用日期:2022-07-25
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