Complicaciones de la cirugía craneofacial en tumores de base craneal anterior
Complications of craniofacial resection in anterior skull base tumors
A. Torres
, J.J. Acebes, L. López, A. Marnov
Servicios de Neurocirugía. Hospital Universitario de Bellvitge. Barcelona
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"apellidos" => "Maños" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Monner" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">***</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicios de Cirugía Plástica. Hospital Universitario de Bellvitge. Barcelona" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] 1 => array:3 [ "entidad" => "Servicios de ORL. Hospital Universitario de Bellvitge. Barcelona" "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0015" ] 2 => array:3 [ "entidad" => "Servicios de Cirugía Maxilofacial. Hospital Universitario de Bellvitge. Barcelona" "etiqueta" => "<span class="elsevierStyleSup">***</span>" "identificador" => "aff0020" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Complications of craniofacial resection in anterior skull base tumors" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-09-29" "fechaAceptado" => "2005-02-20" "PalabrasClave" => array:2 [ "es" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec159082" "palabras" => array:4 [ 0 => "Cirugía craneofacial" 1 => "Base de cráneo" 2 => "Técnica quirúrgica" 3 => "Complicaciones" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abreviaturas" "identificador" => "xpalclavsec159083" "palabras" => array:7 [ 0 => "CCF" 1 => "CFR" 2 => "CSFc" 3 => "LCR" 4 => "ORL" 5 => "RDT" 6 => "RM" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec159084" "palabras" => array:4 [ 0 => "Craniofacial resection" 1 => "Skull base" 2 => "Surgical technique" 3 => "Complications" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los recientes avances en radiología, técnica microquirúrgica y de reconstrucción han permitido que la cirugía craneofacial (CCF) se haya convertido en el tratamiento de elección de la patología tumoral de fosa craneal anterior. A pesar de esto, continua asociándose a una incidencia de complicaciones considerable (24–56%).</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">. Revisión, análisis y manejo de las complicaciones de la CCF en una serie de 41 pacientes.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">41 pacientes diagnosticados de patología tumoral infiltrativa de base craneal anterior, fueron intervenidos mediante CCF, entre 1990 y 2002. La extensión tumoral fue valorada en todos los casos con TC y RMN de la región craneo-facial. Tras determinar el volumen y extensión tumoral se diseñó un tratamiento quirúrgico radical, con el objetivo de conseguir una resección tumoral “en bloque”.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El 63.4% de los pacientes eran varones con una mediana de edad de 57 años (18–73). La histología más frecuente de los tumores fue carcinoma escamoso y la localización habitual fue en los senos paranasales en el 78% (32 de 41 casos). En el 85.4% de los pacientes se realizó una craneotomía bifrontal basal y en el 14.6% restante craneotomía frontoorbitaria unilateral, en un sólo colgajo óseo. El área de resección facial incluía: etmoidectomía (60.9%), etmoido-esfenoidectomía (24.3%), maxilectomía unilateral (39%) y exenteración orbitaria (14.6%). Para la reconstrucción se utilizó: colgajo pediculado pericraneal (100%), colgajos locales (34.1%), colgajos libres microvascularizados (21.9%) e injerto óseo autólogo (19.5%). 20 pacientes (48.7%) presentaron complicaciones postoperatorias, entre las que destacan, como complicaciones mayores la fístula de LCR (12.1%) y la meningitis (7.3%). La mortalidad global fue del 7.3%.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La CCF continua asociándose a una elevada tasa de complicaciones, en general de tipo infeccioso. El perfeccionamiento de las técnicas de reconstrucción permitirán reducir la incidencia de las complicaciones más frecuentes y peligrosas.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The development of new radiographic techniques and the refinement of microsurgery and reconstructive surgery have been the responsible of the establishment of craniofacial resection (CFR) as the standard treatment of anterior skull base tumors. Overall complication rates varies from 24–56%, according to a review of recently published series.</p> <span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">. To describe the complications of CFR in a series of 41 patients and to analyze the management and final outcome.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">From 1990 to 2002, 41 patients underwent CFR for tumors involving the anterior cranial base. The extent of the tumor was always assessed with craniofacial CT-scan and MRI. The objective of the surgical treatment was to achive “on block” removal of the tumor.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The average age was 57 years with a male preponderance (63.4%). Squamous cell carcinoma was the most frequent histopathological type of tumor. The tumors were localized in paranasal sinuses in 78% of the cases. Bifrontal craniotomy was performed in 85.4% and unilateral orbitofrontal craniotomy in 14.6% of the cases. The area of facial resection included: ethmoidectomy (60.9%), ethmoido-sphenoidectomy (24.3%), maxillectomy (39%) and orbital exenteration (14.6%). The reconstruction of the floor of the anterior cranial fossa was performed using pedicled pericranial flap (100%), local (34.1%) or microvascular free flaps (21.9%) and split calvarian graft (19.5%). 20 patients (48.7%) developed post-operative complications, CSF leaks (12.1%) and meningitis (7.3%) being the most frequent major complications. The mortality rate was 7.3%.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CFR has become the standard approach for anterior cranial base tumors. Despite its widespread application, the complication's rate ranges between 24–50% and the procedure carries a risk of significant morbidity and even mortality. Improvement of specific aspects of surgical technique and more refined reconstructive methods will decrease the number of complications.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Torres, A.; Acebes, J.J.; López, L.; Marnov, A.; Viñals, J.; Serra, J.M.; Mañosa, M.; Monner, A.: Complicaciones de la cirugía craneofacial en tumores de base craneal anterior. Neurocirugía 2005; 16:492–498.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transfacial approaches of cancers of the ethmoid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Brasnu" 1 => "O. Laccourreye" 2 => "M. Menard" 3 => "B. Devaux" 4 => "F.X. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 0 | 1 | 1 |
| 2019 Febrero | 0 | 2 | 2 |
| 2018 Febrero | 15 | 7 | 22 |
| 2018 Enero | 25 | 39 | 64 |
| 2017 Diciembre | 28 | 23 | 51 |
| 2017 Noviembre | 54 | 37 | 91 |
| 2017 Octubre | 18 | 10 | 28 |
| 2017 Septiembre | 20 | 8 | 28 |
| 2017 Agosto | 24 | 7 | 31 |
| 2017 Julio | 17 | 4 | 21 |
| 2017 Junio | 24 | 4 | 28 |
| 2017 Mayo | 29 | 8 | 37 |
| 2017 Abril | 29 | 9 | 38 |
| 2017 Marzo | 22 | 8 | 30 |
| 2017 Febrero | 12 | 11 | 23 |
| 2017 Enero | 10 | 5 | 15 |
| 2016 Diciembre | 24 | 11 | 35 |
| 2016 Noviembre | 12 | 5 | 17 |
| 2016 Octubre | 26 | 20 | 46 |
| 2016 Septiembre | 34 | 9 | 43 |
| 2016 Agosto | 47 | 19 | 66 |
| 2016 Julio | 26 | 17 | 43 |
| 2015 Diciembre | 2 | 0 | 2 |
| 2015 Octubre | 1 | 0 | 1 |
| 2015 Agosto | 1 | 0 | 1 |
| 2015 Julio | 5 | 5 | 10 |
| 2015 Junio | 27 | 19 | 46 |
| 2015 Mayo | 38 | 19 | 57 |
| 2015 Abril | 23 | 22 | 45 |
| 2015 Marzo | 16 | 20 | 36 |
| 2015 Febrero | 11 | 14 | 25 |
| 2015 Enero | 23 | 16 | 39 |
| 2014 Diciembre | 20 | 21 | 41 |
| 2014 Noviembre | 15 | 15 | 30 |
| 2014 Octubre | 15 | 18 | 33 |
| 2014 Septiembre | 18 | 20 | 38 |
| 2014 Agosto | 20 | 12 | 32 |
| 2014 Julio | 22 | 13 | 35 |
| 2014 Junio | 24 | 25 | 49 |
| 2014 Mayo | 33 | 15 | 48 |
| 2014 Abril | 27 | 16 | 43 |
| 2014 Marzo | 19 | 20 | 39 |
| 2014 Febrero | 18 | 19 | 37 |
| 2014 Enero | 25 | 22 | 47 |
| 2013 Diciembre | 18 | 20 | 38 |
| 2013 Noviembre | 23 | 14 | 37 |
| 2013 Octubre | 28 | 25 | 53 |
| 2013 Septiembre | 22 | 16 | 38 |
| 2013 Agosto | 34 | 34 | 68 |
| 2013 Julio | 24 | 18 | 42 |
| 2013 Junio | 22 | 19 | 41 |
| 2013 Mayo | 16 | 16 | 32 |
| 2013 Abril | 20 | 17 | 37 |
| 2013 Marzo | 17 | 13 | 30 |
| 2013 Febrero | 16 | 11 | 27 |
| 2013 Enero | 12 | 7 | 19 |
| 2012 Diciembre | 8 | 14 | 22 |
| 2012 Noviembre | 1 | 7 | 8 |
| 2012 Octubre | 0 | 1 | 1 |
| 2012 Septiembre | 0 | 2 | 2 |
| 2012 Enero | 6 | 0 | 6 |
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