Stankiewicz James A, Chow James M
Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Am J Rhinol. 2004 Jan-Feb;18(1):35-40.
Knowledge of anatomy including variations observed with endoscopy or computerized tomography scan is vital to the performance of safe endoscopic sinus surgery. The lower-than-normal skull base/cribriform plate is an anatomic variation, which if not noted preoperatively, can lead to entrance into the brain causing major injury.
Four case studies of chronic rhinosinusitis are reviewed in which either the whole anterior skull base or the cribriform plate is lower than usual and major complications occurred.
All four cases had unilateral or bilateral entrance into the skull base/cribriform plate of the brain in the biopsy specimen, postoperative cerebrospinal fluid leak, and/or brain hemorrhage. One patient died from the injury, three patients had marked neurological sequelae. The low skull base and its meaning for the surgeon is discussed at length.
The preoperative anatomy as determined by endoscopy and computerized tomography scanning has to be identified. Variations or abnormalities should be noted and taken into consideration for preoperative and operative planning. Failure to note skull base or cribriform anatomy variations may lead to brain entrance, injury, and death.
了解包括在内镜检查或计算机断层扫描中观察到的变异在内的解剖结构，对于安全进行鼻内镜鼻窦手术至关重要。颅底/筛板低于正常水平是一种解剖变异，如果术前未被注意到，可能会导致进入脑部并造成严重损伤。
回顾了4例慢性鼻-鼻窦炎病例研究，这些病例中整个前颅底或筛板低于正常水平，并发生了严重并发症。
所有4例患者的活检标本均出现单侧或双侧进入颅底/脑筛板的情况，术后出现脑脊液漏和/或脑出血。1例患者因损伤死亡，另外3例患者有明显的神经后遗症。详细讨论了低颅底及其对外科医生的意义。
必须通过内镜检查和计算机断层扫描确定术前解剖结构。应注意变异或异常情况，并在术前和手术规划中予以考虑。未注意到颅底或筛板解剖变异可能会导致进入脑部、损伤甚至死亡。
