晚期侧颅底恶性肿瘤手术策略的个体化制定：切缘控制中的解剖限制与组织学局限
Tailoring Surgical Strategy for Advanced Lateral Skull Base Malignancies: Anatomical Constraints and Histological Limits in Margin Control.
文献信息
| PMID | 42880711 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Kenichiro Iwami |
| 作者单位 | Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: iwami.kenichiro.f4@f.mail.nagoya-u.ac.jp. |
| 期刊 | World neurosurgery |
| SCI 分区 | Q2 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 根治性颞骨切除术（TBR）适用于晚期侧颅底恶性肿瘤。我们此前将TBR截骨分为前段、内侧段和后段。评估这些切除术中的解剖限制和组织学局限对于优化策略和预防复发至关重要。
方法： 我们回顾性分析了自2014年以来接受整块根治性TBR的38例患者：次全TBR（STBR，n = 17）或侧方TBR（LTBR，n = 21）。6例患者同时进行了上切缘（S段）硬脑膜切除。我们在多平面影像上测量了肿瘤至内侧结构距离（TMSD）。分析了颅底无复发生存期（SBRFS）。
结果： 平均随访时间为65 ± 39个月。LTBR的手术时间短于STBR（P = 0.0126）。6例患者发生颅底复发。两组之间的总体SBRFS无显著差异（P = 0.144）。5例为内侧段复发，且仅发生在LTBR后。冠状位计算机断层扫描（CT）揭示了一个关键盲区：由于鼓膜呈斜位，下鼓室肿瘤在所有5例复发病例中TMSD < 3 mm。在LTBR中，TMSD < 3 mm的患者与≥ 3 mm的患者相比，SBRFS显著更差（P < 0.001）。其余S段复发发生在一例鳞状细胞癌（SCC）中，尽管进行了硬脑膜切除；而软骨母细胞瘤中未发生复发。
结论： 必须有意识地评估冠状位CT。由于下鼓室盲区，TMSD < 3 mm在解剖上禁忌LTBR，必须行STBR。此外，S段硬脑膜切除的疗效似乎取决于组织学，突显了侵袭性SCC中的生物学局限。
英文摘要
BACKGROUND: Radical temporal bone resection (TBR) is indicated for advanced lateral skull base malignancies. We previously classified TBR osteotomies into Anterior, Medial, and Posterior segments. Evaluating anatomical constraints and histological limits in these resections is essential to optimize strategies and prevent recurrence.
METHODS: We retrospectively reviewed 38 patients undergoing en bloc radical TBR since 2014: subtotal TBR (STBR, n = 17) or lateral TBR (LTBR, n = 21). Concomitant superior margin (S-segment) dural resection was performed in 6 patients. We measured the Tumor-to-Medial Structure Distance (TMSD) on multi-planar imaging. Skull base recurrence-free survival (SBRFS) was analyzed.
RESULTS: Mean follow-up was 65 ± 39 months. Operative time was shorter in LTBR than in STBR (P = 0.0126). Skull base recurrences occurred in 6 patients. Overall SBRFS did not differ significantly between groups (P = 0.144). Five were Medial-segment recurrences, exclusively following LTBR. Coronal computed tomography (CT) exposed a critical blind spot: because the tympanic membrane is positioned obliquely, tumors in the hypotympanum had a TMSD < 3 mm in all 5 recurrent cases. Within LTBR, SBRFS was significantly poorer for patients with a TMSD < 3 mm versus ≥ 3 mm (P < 0.001). The remaining S-segment recurrence occurred despite dural resection in a squamous cell carcinoma (SCC), whereas no recurrences occurred in chondroblastomas.
CONCLUSIONS: Conscious coronal CT evaluation is mandatory. A TMSD < 3 mm anatomically contraindicates LTBR due to hypotympanic blind spots, mandating STBR. Furthermore, S-segment dural resection efficacy appears histology-dependent, highlighting biological limits in aggressive SCCs.