Hallacq P, Moreau J J, Fischer G, Béziat J L
Skull Base. 2001 Feb;11(1):35-46. doi: 10.1055/s-2001-12786.
The authors report on their experience with the trans-sinusal frontal approach in removing olfactory groove meningiomas. Six tumors were operated on by the trans-sinusal frontal approach, using a bicoronal incision; two tumors developed on one side, and there were four bilateral olfactosellar tumors. Osteotomy of the anterior wall of the frontal sinus was performed with an oscillating saw without any burr hole. The posterior wall of the sinus was resected and the tumor was attacked through a real subfrontal route along the plane of the anterior skull base. Ethmoidal blood supply was controlled at the initial stages of the operation, allowing avascular tumor debulking. Olfactory nerves, invaded by the tumor, were removed along with the tumor. Tumor extensions toward the sella and the optic canals were removed without brain retraction, opening of the Sylvian fissure, or dissection of the carotid arteries. All patients made a good neurologic recovery; intellectual impairment disappeared within 1 month, and visual acuity normalized within 2 weeks. Olfactory nets were preserved on the contralateral side in unilateral tumors. The trans-sinusal frontal approach is technically easy and safe to achieve. Osteotomy and replacement of the anterior wall of the frontal sinus are rapidly performed. When the frontal sinus is small, imageguided surgery allows precise deliniation of its limits and the free bone flap, including the calvarial outer layer, tangentially cut from one supraorbital canal to the other. The cosmetic result is perfect, as the normal contour of the forehead is maintained without any scar or visible burr hole. The trans-sinusal frontal approach gives access to the orbital roofs and to the central anterior skull base from the crista galli to the tuberculum sellae and the anterior clinoid processes. The trans-sinusal frontal approach represents an alternative to conventional craniotomies for tumors developed in the central anterior skull base, especially for olfactory groove meningiomas, whatever their size.
作者报告了他们采用经鼻窦额部入路切除嗅沟脑膜瘤的经验。6例肿瘤采用经鼻窦额部入路手术，采用双冠状切口；2例肿瘤位于一侧，4例为双侧嗅沟蝶骨嵴肿瘤。使用摆动锯进行额窦前壁截骨，无需钻孔。切除鼻窦后壁，沿前颅底平面经真正的额下途径处理肿瘤。在手术初期控制筛窦血供，实现肿瘤无血切除。被肿瘤侵犯的嗅神经与肿瘤一并切除。向鞍区和视神经管的肿瘤延伸部分无需牵拉脑组织、打开外侧裂或解剖颈动脉即可切除。所有患者神经功能恢复良好；智力障碍在1个月内消失，视力在2周内恢复正常。单侧肿瘤患者对侧的嗅神经网得以保留。经鼻窦额部入路技术操作简单且安全。额窦前壁的截骨和复位操作迅速。当额窦较小时，图像引导手术可精确划定其边界以及从一个眶上管向另一个眶上管切线切割的包括颅骨外层的游离骨瓣。由于前额正常轮廓得以保留，无任何瘢痕或可见钻孔，美容效果极佳。经鼻窦额部入路可从鸡冠至鞍结节和前床突进入眶顶和中央前颅底。经鼻窦额部入路是中央前颅底肿瘤（尤其是嗅沟脑膜瘤，无论其大小）传统开颅手术的一种替代方法。
