V.E. Olyushin, D.A. Gulyaev, A.Yu. Shcherbuk, S.Ya. Chebotarev, N.V. Kolakutsky, O.Yu. Petropavlovskaya, N.Yu. Petropavlovskaya
(Polenov Research Neurosurgical Institute, Saint Petersburg
Pavlov State Medical University, Saint Petersburg
Faculty of Surgical Stomatology, Saint Petersburg)
Male patient D., aged 24, was ill during 4 years. The disease onset was characterized by diplopia, which appeared at a look down, headaches of a meningeal-vascular character. A mass in the area of the right orbit was diagnosed at the place of his residence. He was subject to 2 courses of radiotherapy and 6 courses of chemotherapy. There was aggravation of a state, watched during several months. It manifested itself in stronger headaches, pain in the right half of a face, more marked edema of soft tissues, anabrosis in the area of the lower lid of the right eye, loss of vision in it.
A neurological picture was conditioned by lesion of the second, third, fourth, fifth, sixth, seventh and eighth cranial nerves on the right, left-side pyramidal symptoms. EEG data were indicative of marked irritation of stem structures.
An operation for a craniofacial tumor was performed on May 6, 2004. It included removal of a tumor of the right orbit, pyramid, right temporal bone, upper jaw and replacement of a defect of soft tissues and the skull base with an advanced thoraco-dorsal flap. A postoperative course was severe and characterized by meningoencephalitis and secondary necrosis of soft tissues. There was healing by second intention. The patient was discharged in a compensated state. The flap took root completely. A score according to Karnofsky’s scale was 70.
The demonstration goal was to illustrate potentialities of block-resections of the skull base with a good postoperative functional result.