頭蓋底悪性腫瘍の外科治療

―安全性向上と侵襲軽減の工夫―

抄録

Surgical intervention for malignant tumors of the skull base through collaboration among surgeons from the fields of neurosurgery, head and neck surgery, and plastic surgery has yielded good results over the last two decades. This is considered to be because craniofacial resection (CFR) can be performed without touching the tumor, while preserving the intracranial tissue, and the internal and external cranium can be safely shielded by reconstruction. On the other hand, the surgical risk, postoperative disorders and facial aesthetic problems still pose major problems.

We have developed some methods to make CFR more reliable and safe, e.g., 1) some adequate approaches to the infratemporal fossa; 2) combined use of an endoscope; 3) combined maxillary swing approach and infratemporal fossa approach for nasopharyngeal cancer; 4) skull reconstruction using a custom-made titanium mesh. We also introduced 1) a 3D virtual simulation and navigation system, and 2) psychiatric liaison activity, as examples of efforts to improve the safety.

Team approach is important for surgical treatment of malignant tumors of the skull base. In addition to the surgical team, the safety of skull base malignant tumor treatment will be improved by building a comprehensive team of oncologists, radiation therapists, psychiatrists, clinical psychologists, and nurses.