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目的 探讨鼻咽癌放射治疗 (简称放疗 )后颅底放射性骨坏死的诊断和治疗 ,提高本病的诊治水平。方法 对 15例确诊的鼻咽癌颅底骨坏死患者的资料、临床症状及体征、治疗方式等特点进行分析与总结。结果 颅底放射性骨坏死的常见症状为恶臭、头痛和鼻衄 ;内镜表现为鼻咽坏死 ,可见骨质裸露或死骨形成。CT特征性表现 :骨破坏广泛而对称或局限 ;骨体的表面裸露在气腔中 ;有死骨形成 ;软组织内见小气泡。 9例局限性颅底骨坏死手术治疗 ,2例死于放射性颞叶坏死 ,生存 7例 ,生存时间 2～ 7年。 5例广泛颅底骨坏死和 1例局限性颅底骨坏死保守治疗 ,3例死于鼻咽大出血 ,1例死于呼吸循环衰竭 ,生存 2例 ,生存时间 3～ 5年。结论 颅底骨坏死根据症状结合CT或磁共振成像 (magneticresonanceimaging ,MRI)及内镜特征可作出临床诊断 ,确诊须病理证实 ;手术治疗效果最佳。广泛颅底骨坏死伴放射性脑损伤或颅神经损伤者预后较差 ,鼻咽大出血及衰竭为主要死因
Objective To investigate the diagnosis and treatment of radiation-induced osteonecrosis of skull base after radiation therapy of nasopharyngeal carcinoma (referred to as radiotherapy), and to improve the diagnosis and treatment of this disease. Methods Fifteen cases of skull base osteonecrosis of nasopharyngeal carcinoma were analyzed and summarized according to the data, clinical symptoms and signs, treatment methods and other characteristics. Results The common symptoms of skull base radiosarrow necrosis were malodor, headache and epistaxis. The endoscopic appearance was nasopharyngeal necrosis, showing bone nudity or sequestrum formation. CT features: extensive and symmetrical bone damage or limitations; the body surface exposed in the air cavity of the body; there is the formation of sequestrum; see small bubbles in the soft tissue. Surgical treatment of 9 cases of limited skull base necrosis, 2 cases died of radioactive temporal lobe necrosis, survival in 7 cases, survival time of 2 to 7 years. 5 cases of extensive skull base necrosis and 1 case of limited skull base necrosis conservative treatment, 3 patients died of nasopharyngeal hemorrhage, 1 died of respiratory failure, survival in 2 cases, survival time of 3 to 5 years. Conclusions Skull base osteonecrosis can be diagnosed clinically based on the symptoms combined with CT or magnetic resonance imaging (MRI) and endoscopic features. The pathological findings should be confirmed and the surgical treatment is the best. Extensive skull base bone necrosis with radiation-induced brain injury or cranial nerve injury were poor prognosis, nasopharyngeal bleeding and failure as the main cause of death