Métodos reconstructivos en cirugía tumoral de base de cráneo
Reconstructive techniques in cranial base tumor surgery
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"apellidos" => "Oliveira" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S113014739970970X?idApp=UINPBA00004B" "url" => "/11301473/0000001000000002/v1_201305151007/S113014739970970X/v1_201305151007/es/main.assets" ] "es" => array:13 [ "idiomaDefecto" => true "titulo" => "Métodos reconstructivos en cirugía tumoral de base de cráneo" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "108" "paginaFinal" => "118" ] ] "autores" => array:2 [ 0 => array:3 [ "autoresLista" => "G. Sánchez Aniceto, A. Romance García, R. Gutiérrez Díaz, J. Montalvo Moreno" "autores" => array:4 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Sánchez Aniceto" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Romance García" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Gutiérrez Díaz" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Montalvo Moreno" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Cirugía Maxilofacial. Hospital Universitario 12 de Octubre. Madrid" ] ] ] 1 => array:3 [ "autoresLista" => "R. Díez Lobato, A. Cabrera Yesares" "autores" => array:2 [ 0 => array:3 [ "nombre" => "R." "apellidos" => "Díez Lobato" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Cabrera Yesares" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Neurocirugía. Hospital Universitario 12 de Octubre. Madrid" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Reconstructive techniques in cranial base tumor surgery" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec156627" "palabras" => array:4 [ 0 => "Métodos reconstructivos" 1 => "Base craneal" 2 => "Tumor" 3 => "Abordaje transfacial" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec156628" "palabras" => array:4 [ 0 => "Reconstructive techniques" 1 => "Cranial base" 2 => "Tumor" 3 => "Transfacial approach" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir la experiencia de los autores durante los últimos cinco años en el tratamiento quirúrgico de 37 pacientes con patología tumoral de base de cráneo, dedicando una atención especial a los métodos reconstructivos empleados, y resultados obtenidos en cuanto a supervivencia e incidencia de complicaciones graves.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Un total de 37 pacientes con patología neoplásica de la base craneal fueron intervenidos quirúrgicamente entre octubre de 1992 y septiembre de 1997. Veinte pacientes presentaban tumores benignos o pseudotumores, y diecisiete tumores malignos. Catorce de ellos habían sido sometidos a procedimientos quirúrgicos previos sobre el tumor y cuatro habían recibido radioterapia. La mayor parte de las neoplasias afectaban el segmento anterior de la fosa craneal media (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18), o la fosa craneal anterior, en su sector lateral (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15) o en su sector central (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13). Veintitrés pacientes precisaron abordajes quirúrgicos combinados intra-extracraneales. Los abordajes más comúnmente utilizados han sido los transfrontoorbitarios (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18), el lateral preauricular infratemporal (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13), diversos tipos de maxilotomías (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11), rinotomía pediculada (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5), y translocación facial (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3).</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Describimos los defectos postquirúrgicos de los 37 pacientes en lo que respecta a la integridad o no de la duramadre, vía aerodigestiva superior, piel, esqueleto craneofacial, cavidades (maxilar, órbita, infratemporal), pares craneales y arteria carótida interna. Los métodos reconstructivos empleados incluyeron: colgajos locales (galea-pericráneo, 21 casos; fascia parietotemporal, 4), colgajos miofasciales (músculo temporal, 9 casos; galea-frontal 2 casos), miocutáneos (pectoral mayor, 2 casos) y colgajos libres microvasculares (dorsal ancho, 3 casos; recto abdominal, 1 caso). En 24 casos se reconstruyeron con injertos óseos autólogos (calota craneal) rebordes, paredes orbitarias y/o bóveda craneal. La fijación habitualmente empleada para los segmentos óseos movilizados e injertos fue mediante microosteosíntesis con placas y tornillos de titanio. En 13 pacientes se empleó el metilmetacrilato para defectos extensos craneales o relleno de fosa temporal.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En 31 pacientes (84% de los casos) se consiguió resección completa del tumor. Un paciente falleció en el postoperatorio tardío (4 semanas) por hemorragia incoercible procedente de la arteria carótida interna. Catorce pacientes recibieron radioterapia postoperatoria. El seguimiento medio de los pacientes ha sido de 31 meses (rango 2–60 meses) con una supervivencia global del 80% (69% para los tumores malignos) y una supervivencia libre de enfermedad del 58% (44% para tumores malignos). Veinte pacientes (56%) presentaron complicaciones postquirúrgicas: neurológicas (11 pacientes), relacionadas con el abordaje (9 pacientes), de la herida quirúrgica (7 pacientes), fístula de líquido cefalorraquídeo (4 pacientes), y sistémicas (3 pacientes).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Una metodología reconstructiva adecuada es imprescindible para conseguir resultados aceptables en términos de supervivencia y calidad de vida en pacientes con patología tumoral de base de cráneo.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">In this article the authors describe their experience during the last five years with the surgical treatment of 37 patients presenting skull base neoplasms. Special attention is given to reconstructive techniques and the final results in terms of survival and major complications.</p> <span class="elsevierStyleSectionTitle">Methods and materials</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Thirty-seven patiens with skull base neoplasms underwent surgical treatment between october, 1992 and september, 1997. Twenty patients presented with benign tumors or pseudotumor, and seventeen had malignant neoplasms. Fourteen patients underwent previous surgical procedures and four also received radiation therapy. Most tumors affected the middle cranial fossa at its anterior segment (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18) or the anterior cranial fossa at its lateral (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15) or central portion (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13). Twenty-three patients underwent combined intra-extracranial approaches. The most commonly used approaches were transfrontoorbital (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18), lateral preauricular-infratemporal (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13), different types of maxillotomies (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11), pedided rhinotomy (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5) and facial translocation (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3). Postsurgical deffects in the 37 patients are described in detail, namely integrity of duramater, superior aerodigestive tract, skin, craniofacial skeleton, cavities (maxilla, orbit, infratemporal), cranial nerves, and internal carotid artery. Reconstructive techniques induded: local flaps (galeal-pericranial, 21 cases; temporoparietalis fascia, 4), myofascial flaps (temporalis musde, 9 cases; galeal-frontalis, 2 cases), myocutaneous (pectoralis major, 2 cases), and microvascular free flaps (lattissimus dorsi, 3 cases, rectus abdominis, 1 case). In 24 cases, autologous bone grafts (calvarial) were used to reconstruct orbital rims, walls or cranial vault defects. Osteotomized bone segments and grafts were usually fixed with titanium microplates and screws. Thirteen patiens underwent cranial vault or temporal fossa methyl-methacrylate reconstruction.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In thirty-one cases (84%) complete resection of tumor was achieved. One patient died in the late postoperative period (4 weeks) due to internal carotid artery bleeding. Fourteen patients received postoperative radiation therapy. Medium follow-up has been 31 months (range 2–60 months); the overall survival rate was 80% (69% for malignant tumors) and the disease-free survival rate 58% (44% for malignant tumors). Twenty patients (56%) suffered postsurgical complications: neurologic (11 patients), approach-related (9 patients), surgical wound related (7 patients), cerebrospinal fluid fistula (4 patients) and systemic (3 patients).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Suitable reconstructive principIes are essential to achieve fair results in terms of survival and life-quality in patients with skull base neoplasms.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Sánchez Aniceto, G.; Romance García, A.I.; Gutiérrez Díaz, R.; Montalvo Moreno, J.J.; Díez Lobato, R.; Cabrera Yesares, A.: Métodos reconstructivos en cirugía tumoral de base de cráneo. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 4 | 1 | 5 |
| 2018 February | 8 | 6 | 14 |
| 2018 January | 12 | 11 | 23 |
| 2017 December | 9 | 9 | 18 |
| 2017 November | 44 | 19 | 63 |
| 2017 October | 4 | 16 | 20 |
| 2017 September | 7 | 20 | 27 |
| 2017 August | 6 | 6 | 12 |
| 2017 July | 8 | 19 | 27 |
| 2017 June | 7 | 25 | 32 |
| 2017 May | 14 | 15 | 29 |
| 2017 April | 9 | 20 | 29 |
| 2017 March | 9 | 20 | 29 |
| 2017 February | 2 | 12 | 14 |
| 2017 January | 6 | 10 | 16 |
| 2016 December | 15 | 16 | 31 |
| 2016 November | 15 | 15 | 30 |
| 2016 October | 27 | 30 | 57 |
| 2016 September | 25 | 22 | 47 |
| 2016 August | 34 | 11 | 45 |
| 2016 July | 28 | 24 | 52 |
| 2015 December | 3 | 0 | 3 |
| 2015 September | 0 | 12 | 12 |
| 2015 July | 2 | 6 | 8 |
| 2015 June | 12 | 17 | 29 |
| 2015 May | 24 | 31 | 55 |
| 2015 April | 15 | 26 | 41 |
| 2015 March | 13 | 18 | 31 |
| 2015 February | 19 | 30 | 49 |
| 2015 January | 12 | 21 | 33 |
| 2014 December | 17 | 24 | 41 |
| 2014 November | 16 | 15 | 31 |
| 2014 October | 17 | 28 | 45 |
| 2014 September | 18 | 26 | 44 |
| 2014 August | 17 | 31 | 48 |
| 2014 July | 18 | 31 | 49 |
| 2014 June | 28 | 28 | 56 |
| 2014 May | 25 | 29 | 54 |
| 2014 April | 14 | 28 | 42 |
| 2014 March | 17 | 30 | 47 |
| 2014 February | 15 | 29 | 44 |
| 2014 January | 16 | 32 | 48 |
| 2013 December | 21 | 20 | 41 |
| 2013 November | 21 | 19 | 40 |
| 2013 October | 25 | 36 | 61 |
| 2013 September | 24 | 36 | 60 |
| 2013 August | 26 | 27 | 53 |
| 2013 July | 34 | 30 | 64 |
| 2013 June | 22 | 36 | 58 |
| 2013 May | 16 | 30 | 46 |
| 2013 April | 20 | 29 | 49 |
| 2013 March | 12 | 27 | 39 |
| 2013 February | 8 | 21 | 29 |
| 2013 January | 11 | 27 | 38 |
| 2012 December | 9 | 14 | 23 |
| 2012 November | 0 | 11 | 11 |
| 2012 October | 0 | 1 | 1 |
| 2012 September | 0 | 2 | 2 |
| 2012 January | 10 | 0 | 10 |
Show all
