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1997年4月から2004年3月までに当科において手術を施行した頭蓋底進展の悪性腫瘍症例は14例である（前・中頭蓋底8例，側頭骨4例，頸椎～斜台2例）。このうちen-bloc切除を行なえた症例は11例であった。手術時間および出血量は側頭骨手術が前・中頭蓋底の約2倍であった。局所再発は不完全切除例3例で認められ，完全切除例では局所の再発はなかった。死亡例3例中2例は遠隔転移ないしリンパ節転移再発による原病死で，1例は術後ARDSによる呼吸不全で死亡した。合併症は前・中頭蓋底ではなかったが側頭骨症例で全例が皮下髄液漏，2例で髄膜炎を認め，1例がARDSにより死亡した。手術成績の向上のためには，術前に転移の有無を見極めることと完全切除が極めて重要であり，側頭骨手術の術式の洗練と術後管理の徹底が必要である。

Aneurysms of the superficial temporal artery are infrequent, and most of them are traumatic aneurysms located on the superior temporal line. We present a rare case of preauricular aneurysm of the superficial temporal artery. The patient was an 81-year-old woman who had a pulsating mass in the preauricular lesion. It was successfully removed by surgery. Histopathologically, it was suggested to be an aneurysm of the superficial temporal artery caused by atypical arteritis. She has not had active inflammatory findings, but follow-up is needed.

A 50-year-old male had severe tracheal stenosis by a mediastinal goiter. The narrowest trachea part was 2mm in diameter. Therefore we scheduled the use of percutaneous cardiopulmonary support (PCPS) during tracheal intubation. By this method, we could perform tracheal intubation safely and lt-hemithyroidectomy. PCPS is a useful technique for managing severe tracheal stenosis before maintenance of the airway.

患側の声門上部を広範に合併切除する咽喉頭部分切除において, 有茎の骨筋弁と遊離前腕皮弁で声門上部と下咽頭を再建する手術を考案した。胸骨舌骨筋を茎とした舌骨半部で喉頭蓋の部分欠損を再建するとともにその有茎筋弁で披裂部の隆起を形成した後に, 前腕皮弁を用いて声門上部を被覆し下咽頭腔を再建するという方法である。これまでに下咽頭癌5例に行い, 術後の喉頭機能を評価した。全例が気切口を閉鎖でき音声が温存された。5例中4例はほぼ正常な声であった。嚥下機能は2例がほぼ正常, 2例が軽度障害, 1例が高度障害であり, 両側頸部郭清や下咽頭腔の全周切除を要さず, 術前に通過障害がないT2梨状陥凹癌例が良好な嚥下機能を示した。以上より, 咽喉頭部分切除における声門上部再建術は喉頭機能を温存するのに有用な手術方法であると考えられた。

Negative-pressure pulmonary edema (NPPE) is an uncommon but life-threatening complication of acute or chronic upper airway obstruction; however, there are few reports of NPPE after giant goiter resection. We report a case with severe NPPE induced by the resection of a mediastinum thyroid goiter. The patient was successfully treated by non-invasive positive airway ventilation (NPPV).

A case of ethmoid fibrous dysplasia with unilateral chronic sinusitis was reported. The patient was a 21-year-old male who had complained of left nasal obstruction for several years. A plain radiogram of the paranasal sinuses revealed an opaque shadow visible only in the left ethmoid and maxillary sinuses, which induced the unilateral sinusitis. However, amorphous sclerotic changes mainly in portions of the left ethmoid bone were visible in the CT image, which were suggestive of fibrous dysplasia.As the patient had no symptoms other than left nasal obstruction, a Caldwell-Luc antrotomy, with partial resection of the left inferior turbinate, was performed. At the same time, a transantral biopsy of the ethmoid bone was carried out, and the subsequent pathological diagnosis was fibrous dysplasia.Although fibrous dysplasia of ethmoid bone is rare, physicians should be aware of the possibility of this disease in cases of unilateral sinusitis.

En bloc resection of the temporal bone was performed by the lateral approach on two patients with carcinoma of the middle ear, which was associated with destruction in the temporal bone and tumor infiltration of the cranial base. In one of the patients, the petrous apex was resected along with the temporal bone. En bloc resection on the temporal bone with the petrous apex is believed to be difficult because the internal carotid artery (ICA), cavernous sinus, and the brainstem are adjacent to each other in the petrous apex. However, the intra- and extracranial surgical procedures by this approach allow resection of the temporal bone ranging from the anterior part including the petrous apex to the posterior part including the mastoid process, the dura of the middle and posterior cranial fossae, and the sigmoid sinus, without exposure of the tumor. Special attention should be paid to the procedural points of surgery, such as, exposure of the petrous ICA, bleeding from the petrous sinus, and dural suturing in the vicinity of the apex. With regard to surgical indication, it is important to determine whether tumor infiltration is confined to the temporal bone and the dura of the middle and posterior fossa. If tumor infiltration into the petrous ICA, the dominant side of sigmoid sinus and/or the inferior cranial nerve is observed, then indication for surgery should be determined in a more critical manner.