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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 4 | 1 | 5 |
| 2018 Febrero | 8 | 6 | 14 |
| 2018 Enero | 12 | 11 | 23 |
| 2017 Diciembre | 9 | 9 | 18 |
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| 2017 Octubre | 4 | 16 | 20 |
| 2017 Septiembre | 7 | 20 | 27 |
| 2017 Agosto | 6 | 6 | 12 |
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| 2017 Junio | 7 | 25 | 32 |
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| 2017 Marzo | 9 | 20 | 29 |
| 2017 Febrero | 2 | 12 | 14 |
| 2017 Enero | 6 | 10 | 16 |
| 2016 Diciembre | 15 | 16 | 31 |
| 2016 Noviembre | 15 | 15 | 30 |
| 2016 Octubre | 27 | 30 | 57 |
| 2016 Septiembre | 25 | 22 | 47 |
| 2016 Agosto | 34 | 11 | 45 |
| 2016 Julio | 28 | 24 | 52 |
| 2015 Diciembre | 3 | 0 | 3 |
| 2015 Septiembre | 0 | 12 | 12 |
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| 2015 Mayo | 24 | 31 | 55 |
| 2015 Abril | 15 | 26 | 41 |
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| 2015 Febrero | 19 | 30 | 49 |
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| 2014 Octubre | 17 | 28 | 45 |
| 2014 Septiembre | 18 | 26 | 44 |
| 2014 Agosto | 17 | 31 | 48 |
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| 2014 Junio | 28 | 28 | 56 |
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| 2014 Marzo | 17 | 30 | 47 |
| 2014 Febrero | 15 | 29 | 44 |
| 2014 Enero | 16 | 32 | 48 |
| 2013 Diciembre | 21 | 20 | 41 |
| 2013 Noviembre | 21 | 19 | 40 |
| 2013 Octubre | 25 | 36 | 61 |
| 2013 Septiembre | 24 | 36 | 60 |
| 2013 Agosto | 26 | 27 | 53 |
| 2013 Julio | 34 | 30 | 64 |
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| 2013 Marzo | 12 | 27 | 39 |
| 2013 Febrero | 8 | 21 | 29 |
| 2013 Enero | 11 | 27 | 38 |
| 2012 Diciembre | 9 | 14 | 23 |
| 2012 Noviembre | 0 | 11 | 11 |
| 2012 Octubre | 0 | 1 | 1 |
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