難治性前頭蓋底膿瘍の一期的郭清と腹直筋皮弁を用いた前頭蓋底の形成

Single stage excision for an intractable brain abscess and free rectus abdominis flap for reconstruction of the anterior skull base

I．緒言

　メチシリン耐性黄色ブドウ球菌（MRSA）は，難治性の感染症の起因菌として，各科でその治療，対策が検討されている．脳膿瘍を形成した場合も，その治療には，しばしば難渋する^15）．

　一方，近年の顔面を含む前頭蓋底部の病変に対する外科的な技術の進歩は著しく，以前は治療不能と思われた顔面頭蓋の腫瘍に対して，拡大摘出が可能となり，治療成績も良好である．今回われわれは，上顎洞内原発の扁平上皮癌摘出後，前頭蓋底より右前頭葉内，さらに海綿静脈洞を介し右側頭葉内に生じた脳膿瘍の症例に対し，根治的郭清術及び腹直筋皮弁を用いた前頭蓋底形成を行い，良好な結果を得たので，若干の文献的考察を加え報告する．

A case is presented of the frontal brain abscess fol-lowing resection of squamous cell carcinoma of the maxillary sinus who had undergone reconstruction of the anterior skull base using a free rectus abdominis muscle flap. Local flap, ex. galeal flap, can be used for separating the cranial space from the paranasal sinuses and the nasopharynx, but it cannot provide reliable separation and protection of the brain from bacterial flora of the upper airway and it is too weak to support the brain in cases where orbital exenteration has been performed. The distant flaps such as the pectoralis ma-jor musculocutaneous flap, on the other hand, can pro-vide a good alternative for reconstruction of the anter-ior skull base in such difficult cases, but frequently re-quires a secondary division of the pedicle. The free flap can circumvent such problems. We used the free rectus abdominis muscle flap and the postoperative course was uneventful. A bone graft was not necessary to re-construct the anterior skull base.