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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir la experiencia de los autores durante los &#250;ltimos cinco a&#241;os en el tratamiento quir&#250;rgico de 37 pacientes con patolog&#237;a tumoral de base de cr&#225;neo&#44; dedicando una atenci&#243;n especial a los m&#233;todos reconstructivos empleados&#44; y resultados obtenidos en cuanto a supervivencia e incidencia de complicaciones graves&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Un total de 37 pacientes con patolog&#237;a neopl&#225;sica de la base craneal fueron intervenidos quir&#250;rgicamente entre octubre de 1992 y septiembre de 1997&#46; Veinte pacientes presentaban tumores benignos o pseudotumores&#44; y diecisiete tumores malignos&#46; Catorce de ellos hab&#237;an sido sometidos a procedimientos quir&#250;rgicos previos sobre el tumor y cuatro hab&#237;an recibido radioterapia&#46; La mayor parte de las neoplasias afectaban el segmento anterior de la fosa craneal media &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41;&#44; o la fosa craneal anterior&#44; en su sector lateral &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; o en su sector central &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&#46; Veintitr&#233;s pacientes precisaron abordajes quir&#250;rgicos combinados intra-extracraneales&#46; Los abordajes m&#225;s com&#250;nmente utilizados han sido los transfrontoorbitarios &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41;&#44; el lateral preauricular infratemporal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&#44; diversos tipos de maxilotom&#237;as &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&#44; rinotom&#237;a pediculada &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; y translocaci&#243;n facial &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Describimos los defectos postquir&#250;rgicos de los 37 pacientes en lo que respecta a la integridad o no de la duramadre&#44; v&#237;a aerodigestiva superior&#44; piel&#44; esqueleto craneofacial&#44; cavidades &#40;maxilar&#44; &#243;rbita&#44; infratemporal&#41;&#44; pares craneales y arteria car&#243;tida interna&#46; Los m&#233;todos reconstructivos empleados incluyeron&#58; colgajos locales &#40;galea-pericr&#225;neo&#44; 21 casos&#59; fascia parietotemporal&#44; 4&#41;&#44; colgajos miofasciales &#40;m&#250;sculo temporal&#44; 9 casos&#59; galea-frontal 2 casos&#41;&#44; miocut&#225;neos &#40;pectoral mayor&#44; 2 casos&#41; y colgajos libres microvasculares &#40;dorsal ancho&#44; 3 casos&#59; recto abdominal&#44; 1 caso&#41;&#46; En 24 casos se reconstruyeron con injertos &#243;seos aut&#243;logos &#40;calota craneal&#41; rebordes&#44; paredes orbitarias y&#47;o b&#243;veda craneal&#46; La fijaci&#243;n habitualmente empleada para los segmentos &#243;seos movilizados e injertos fue mediante microosteos&#237;ntesis con placas y tornillos de titanio&#46; En 13 pacientes se emple&#243; el metilmetacrilato para defectos extensos craneales o relleno de fosa temporal&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En 31 pacientes &#40;84&#37; de los casos&#41; se consigui&#243; resecci&#243;n completa del tumor&#46; Un paciente falleci&#243; en el postoperatorio tard&#237;o &#40;4 semanas&#41; por hemorragia incoercible procedente de la arteria car&#243;tida interna&#46; Catorce pacientes recibieron radioterapia postoperatoria&#46; El seguimiento medio de los pacientes ha sido de 31 meses &#40;rango 2&#8211;60 meses&#41; con una supervivencia global del 80&#37; &#40;69&#37; para los tumores malignos&#41; y una supervivencia libre de enfermedad del 58&#37; &#40;44&#37; para tumores malignos&#41;&#46; Veinte pacientes &#40;56&#37;&#41; presentaron complicaciones postquir&#250;rgicas&#58; neurol&#243;gicas &#40;11 pacientes&#41;&#44; relacionadas con el abordaje &#40;9 pacientes&#41;&#44; de la herida quir&#250;rgica &#40;7 pacientes&#41;&#44; f&#237;stula de l&#237;quido cefalorraqu&#237;deo &#40;4 pacientes&#41;&#44; y sist&#233;micas &#40;3 pacientes&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Una metodolog&#237;a reconstructiva adecuada es imprescindible para conseguir resultados aceptables en t&#233;rminos de supervivencia y calidad de vida en pacientes con patolog&#237;a tumoral de base de cr&#225;neo&#46;</p>"
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        "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&#46; Special attention is given to reconstructive techniques and the final results in terms of survival and major complications&#46;</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&#44; 1992 and september&#44; 1997&#46; Twenty patients presented with benign tumors or pseudotumor&#44; and seventeen had malignant neoplasms&#46; Fourteen patients underwent previous surgical procedures and four also received radiation therapy&#46; Most tumors affected the middle cranial fossa at its anterior segment &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41; or the anterior cranial fossa at its lateral &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; or central portion &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&#46; Twenty-three patients underwent combined intra-extracranial approaches&#46; The most commonly used approaches were transfrontoorbital &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41;&#44; lateral preauricular-infratemporal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&#44; different types of maxillotomies &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&#44; pedided rhinotomy &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41; and facial translocation &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46; Postsurgical deffects in the 37 patients are described in detail&#44; namely integrity of duramater&#44; superior aerodigestive tract&#44; skin&#44; craniofacial skeleton&#44; cavities &#40;maxilla&#44; orbit&#44; infratemporal&#41;&#44; cranial nerves&#44; and internal carotid artery&#46; Reconstructive techniques induded&#58; local flaps &#40;galeal-pericranial&#44; 21 cases&#59; temporoparietalis fascia&#44; 4&#41;&#44; myofascial flaps &#40;temporalis musde&#44; 9 cases&#59; galeal-frontalis&#44; 2 cases&#41;&#44; myocutaneous &#40;pectoralis major&#44; 2 cases&#41;&#44; and microvascular free flaps &#40;lattissimus dorsi&#44; 3 cases&#44; rectus abdominis&#44; 1 case&#41;&#46; In 24 cases&#44; autologous bone grafts &#40;calvarial&#41; were used to reconstruct orbital rims&#44; walls or cranial vault defects&#46; Osteotomized bone segments and grafts were usually fixed with titanium microplates and screws&#46; Thirteen patiens underwent cranial vault or temporal fossa methyl-methacrylate reconstruction&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In thirty-one cases &#40;84&#37;&#41; complete resection of tumor was achieved&#46; One patient died in the late postoperative period &#40;4 weeks&#41; due to internal carotid artery bleeding&#46; Fourteen patients received postoperative radiation therapy&#46; Medium follow-up has been 31 months &#40;range 2&#8211;60 months&#41;&#59; the overall survival rate was 80&#37; &#40;69&#37; for malignant tumors&#41; and the disease-free survival rate 58&#37; &#40;44&#37; for malignant tumors&#41;&#46; Twenty patients &#40;56&#37;&#41; suffered postsurgical complications&#58; neurologic &#40;11 patients&#41;&#44; approach-related &#40;9 patients&#41;&#44; surgical wound related &#40;7 patients&#41;&#44; cerebrospinal fluid fistula &#40;4 patients&#41; and systemic &#40;3 patients&#41;&#46;</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&#46;</p>"
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                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Osseous lesions anterior and middle base"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;J&#46; Derome"
                            1 => "A&#46; Visot"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Surgery of Cranial Base Tumors"
                        "paginaInicial" => "809"
                        "paginaFinal" => "817"
                        "serieFecha" => "1993"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "D&#237;ez Lobato&#44; R&#46;&#44; Romance Garc&#237;a&#44; A&#46;&#44; S&#225;nchez Aniceto&#44; G&#46;&#44; Rivero&#44; B&#46; y Campollo&#44; J&#46;&#58; La translocaci&#243;n facial ampliada en la resecci&#243;n de tumores de la base craneal&#46; Nuestra experiencia con tres casos&#46; Neurocirug&#237;a &#40;En prensa&#41;&#46;"
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meningiomas del ala esfenoidal&#46; A prop&#243;sito de 90 casos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:5 [
                            0 => "R&#46; D&#237;ez Lobato"
                            1 => "R&#46; Alday"
                            2 => "P&#46;A&#46; G&#243;mez"
                            3 => "J&#46; Ayerbe"
                            4 => "G&#46; S&#225;nchez Aniceto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Neurocirug&#237;a"
                        "fecha" => "1999"
                        "volumen" => "10"
                        "paginaInicial" => "13"
                        "paginaFinal" => "26"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infratemporal fossa approach to lesions in the temporal bone and base of the skull"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "U&#46; Fisch"
                            1 => "H&#46;C&#46; Pillsbury"
                            2 => "C&#46;T&#46; Sasaki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Arch Otolaryngol Head Neck Surg"
                        "fecha" => "1979"
                        "volumen" => "105"
                        "paginaInicial" => "99"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transfacial access to the retromaxillary area"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46; Hern&#225;ndez Altemir"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Maxillofac Surg"
                        "fecha" => "1986"
                        "volumen" => "14"
                        "paginaInicial" => "165"
                        "paginaFinal" => "170"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3014030"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical management of intraorbital tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46;M&#46; Housepian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:3 [
                        "titulo" => "Operative neurosurgical technique"
                        "paginaInicial" => "183"
                        "serieFecha" => "1995"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tumors of skull base&#58; outcome and survival analysis of 77 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;C&#46; Irish"
                            1 => "P&#46; Gullane"
                            2 => "F&#46; Gentili"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Head Neck"
                        "fecha" => "1994"
                        "volumen" => "16"
                        "paginaInicial" => "3"
                        "paginaFinal" => "10"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8125786"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of the galeal frontalis myofascial flap in craniofacial surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46;T&#46; Jackson"
                            1 => "M&#46;N&#46; Adham"
                            2 => "R&#46; Marsh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "1986"
                        "volumen" => "77"
                        "paginaInicial" => "905"
                        "paginaFinal" => "909"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3714887"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results and prognosis following surgery for malignant tumors of the skull base"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46;T&#46; Jackson"
                            1 => "M&#46;H&#46; Bailey"
                            2 => "W&#46;R&#46; Marsh"
                            3 => "P&#46; Juhasz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Head Neck"
                        "fecha" => "1991"
                        "volumen" => "13"
                        "paginaInicial" => "89"
                        "paginaFinal" => "96"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2022484"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical access to the base of skull and upper cervical spine by extended maxillotomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; James"
                            1 => "H&#46;A&#46; Crockard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurosurgery"
                        "fecha" => "1991"
                        "volumen" => "29"
                        "paginaInicial" => "411"
                        "paginaFinal" => "416"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1922707"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical Management of cranial base tumors&#58; A report on 91 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "I&#46;P&#46; Janecka"
                            1 => "L&#46;N&#46; Sekhar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Oncology"
                        "fecha" => "1989"
                        "volumen" => "3"
                        "paginaInicial" => "69"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2491449"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Free Rectus abdominis muscle flap reconstructi&#243;n of the middle and posterior cranial base"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46;L&#46; Jones"
                            1 => "L&#46;N&#46; Sekhar"
                            2 => "V&#46;L&#46; Schramm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "1986"
                        "volumen" => "78"
                        "paginaInicial" => "471"
                        "paginaFinal" => "477"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2945217"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Orbitozygomatic infratemporal approach to lateral skull base tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;P&#46; Lee"
                            1 => "M&#46;S&#46; Tsai"
                            2 => "Y&#46;R&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Neurol Scand"
                        "fecha" => "1993"
                        "volumen" => "87"
                        "paginaInicial" => "403"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8392773"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A conceptual approach to learning and organizing the surgical anatomy of the skull base"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;G&#46; Nasser"
                            1 => "E&#46;L&#46; Attie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Otolaryngology"
                        "fecha" => "1990"
                        "volumen" => "19"
                        "paginaInicial" => "114"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications of skull base surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46;T&#46; Nguyen"
                            1 => "J&#46;B&#46; Delashaw Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Plast Surg"
                        "fecha" => "1995"
                        "volumen" => "22"
                        "paginaInicial" => "573"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7554725"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Temporal approach to the TMJ&#44; the orbit&#44; and the retromaxillary-infracranial region"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;L&#46; Obwegeser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Head Neck Surg"
                        "fecha" => "1985"
                        "volumen" => "7"
                        "paginaInicial" => "185"
                        "paginaFinal" => "199"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3972598"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extended anterior subcranial approach for skull base tumors&#58; long-term results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Raveh"
                            1 => "J&#46;B&#46; Turk"
                            2 => "K&#46; L&#228;drach"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.1995.82.6.1002"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "1995"
                        "volumen" => "82"
                        "paginaInicial" => "1002"
                        "paginaFinal" => "1010"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7760173"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tumores orbitarios&#46; Cirug&#237;a de la base del cr&#225;neo"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Romance Garc&#237;a"
                            1 => "R&#46; Guti&#233;rrez D&#237;az"
                            2 => "G&#46; S&#225;nchez Aniceto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Cirug&#237;a Oral y Maxilofacial&#46; Manual del Residente"
                        "paginaInicial" => "901"
                        "paginaFinal" => "936"
                        "serieFecha" => "1997"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Orbital Surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Rootman"
                            1 => "F&#46; Durity"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Surgery of Cranial Base Tumors"
                        "paginaInicial" => "769"
                        "paginaFinal" => "785"
                        "serieFecha" => "1993"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maxilotom&#237;a ampliada &#40;Lefort I con segmentaci&#243;n sagital&#41; como v&#237;a de abordaje a la base craneal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; S&#225;nchez Aniceto"
                            1 => "A&#46; Silv&#225;n Gonz&#225;lez de Rivera"
                            2 => "J&#46;C&#46; Moreno V&#225;zquez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Neurocirug&#237;a"
                        "fecha" => "1996"
                        "volumen" => "7"
                        "paginaInicial" => "11"
                        "paginaFinal" => "17"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transoral approach to the nasopharyns and clivus using the Lefort I osteotomy with midpalatal split"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46;K&#46;B&#46; Sandor"
                            1 => "D&#46;A&#46; Charles"
                            2 => "V&#46;G&#46; Lawson"
                            3 => "C&#46;H&#46; Tator"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Oral Maxillofac Surg"
                        "fecha" => "1990"
                        "volumen" => "19"
                        "paginaInicial" => "352"
                        "paginaFinal" => "355"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1964951"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subtemporal preauricular infratemporal fossa approach to large lateral and posterior cranial base neoplasms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;N&#46; Sekhar"
                            1 => "V&#46;L&#46; Schramm Jr&#46;"
                            2 => "N&#46;F&#46; Jones"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.1987.67.4.0488"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "1987"
                        "volumen" => "67"
                        "paginaInicial" => "488"
                        "paginaFinal" => "499"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3655886"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The extended frontal approach to tumors of the anterior&#44; middle and posterior skull base"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46;N&#46; Sekhar"
                            1 => "A&#46; Nanda"
                            2 => "C&#46;N&#46; Sen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.1992.76.2.0198"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "1992"
                        "volumen" => "76"
                        "paginaInicial" => "198"
                        "paginaFinal" => "206"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1730948"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications in Skull Base Operations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Ch&#46; Sen"
                            1 => "C&#46;H&#46; Snyderman"
                            2 => "L&#46;N&#46; Sekhar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Surgery of Cranial Base Tumors"
                        "paginaInicial" => "831"
                        "paginaFinal" => "839"
                        "serieFecha" => "1993"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Craniofacial resections for tumors involving the base of the skull"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "lP&#46; Shah"
                            1 => "N&#46; Sundaresan"
                            2 => "J&#46; Galicich"
                            3 => "E&#46;W&#46; Strong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Surg"
                        "fecha" => "1987"
                        "volumen" => "154"
                        "paginaInicial" => "352"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3661836"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An analysis of extradural dead space after fronto-orbital surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46;M&#46; Spinelli"
                            1 => "D&#46; Irizarry"
                            2 => "J&#46;G&#46; McCarthy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "1995"
                        "volumen" => "22"
                        "paginaInicial" => "555"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reconstruction of the cranial base"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46;M&#46; Spinelli"
                            1 => "J&#46;A&#46; Persing"
                            2 => "B&#46; Walser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Plast Surg"
                        "fecha" => "1995"
                        "volumen" => "22"
                        "paginaInicial" => "555"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7554723"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cranio-Orbital reconstruction&#58; safety and image quality of metallic implants of CT and MRI scanning"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;K&#46; Sullivan"
                            1 => "J&#46;F&#46; Smith"
                            2 => "A&#46;A&#46; Rozelle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "1994"
                        "volumen" => "94"
                        "paginaInicial" => "589"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7938281"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Osteotomies cranio-naso-orbito-faciales hypertelorisme"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Tessier"
                            1 => "G&#46; Guiot"
                            2 => "J&#46; Rougerie"
                            3 => "J&#46;P&#46; Delbet"
                            4 => "J&#46; Pastoriza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Chir Plast"
                        "fecha" => "1967"
                        "volumen" => "12"
                        "paginaInicial" => "103"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5595910"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Free tissue transfer for skull base reconstruction&#46; Analysis of complications and a classification scheme for defining skull base defects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;L&#46; Urken"
                            1 => "P&#46;J&#46; Catalano"
                            2 => "C&#46; Sen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Otolaryngol Head Neck Surg"
                        "fecha" => "1993"
                        "volumen" => "119"
                        "paginaInicial" => "1318"
                        "paginaFinal" => "1325"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17431985"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lateral rhinotomy and medial maxillectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Weisman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Otolaryngol Clin North Am"
                        "fecha" => "1995"
                        "volumen" => "28"
                        "paginaInicial" => "1145"
                        "paginaFinal" => "1156"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8927390"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The utility of pericranial flaps"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;A&#46; Wolfe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Plast Surg"
                        "fecha" => "1978"
                        "volumen" => "1"
                        "paginaInicial" => "146"
                        "itemHostRev" => array:3 [
                          "pii" => "S120197120900318X"
                          "estado" => "S300"
                          "issn" => "12019712"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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Vol. 10. Issue 2.
Pages 108-118 (January 1999)
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Vol. 10. Issue 2.
Pages 108-118 (January 1999)
Métodos reconstructivos en cirugía tumoral de base de cráneo
Reconstructive techniques in cranial base tumor surgery
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G. Sánchez Aniceto, A. Romance García, R. Gutiérrez Díaz, J. Montalvo Moreno
Servicio de Cirugía Maxilofacial. Hospital Universitario 12 de Octubre. Madrid
R. Díez Lobato*, A. Cabrera Yesares*
* Servicio de Neurocirugía. Hospital Universitario 12 de Octubre. Madrid
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Article information
Resumen
Objetivos

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.

Material y métodos

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=18), o la fosa craneal anterior, en su sector lateral (n=15) o en su sector central (n=13). Veintitrés pacientes precisaron abordajes quirúrgicos combinados intra-extracraneales. Los abordajes más comúnmente utilizados han sido los transfrontoorbitarios (n=18), el lateral preauricular infratemporal (n=13), diversos tipos de maxilotomías (n=11), rinotomía pediculada (n=5), y translocación facial (n=3).

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.

Resultados

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).

Conclusiones

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.

Palabras clave:
Métodos reconstructivos
Base craneal
Tumor
Abordaje transfacial
Summary

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.

Methods and materials

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=18) or the anterior cranial fossa at its lateral (n=15) or central portion (n=13). Twenty-three patients underwent combined intra-extracranial approaches. The most commonly used approaches were transfrontoorbital (n=18), lateral preauricular-infratemporal (n=13), different types of maxillotomies (n=11), pedided rhinotomy (n=5) and facial translocation (n=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.

Results

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).

Conclusions

Suitable reconstructive principIes are essential to achieve fair results in terms of survival and life-quality in patients with skull base neoplasms.

Key words:
Reconstructive techniques
Cranial base
Tumor
Transfacial approach

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