Fujitsu K, Saijoh M, Aoki F, Sakata K, Fujii S, Mochimatsu Y, Kuwabara T
Department of Neurosurgery, Yokohama City University School of Medicine, Japan.
Neurosurgery. 1991 May;28(5):714-9; discussion 719-20. doi: 10.1097/00006123-199105000-00013.
In three cases involving meningiomas in the ethmoid and sphenoid sinuses, transbasal spreading of the interocular distance (telecanthal approach) was used for tumor removal and reconstruction of the skull base. This telecanthal approach involves 1) bilateral en bloc removal of the superior lateral rim of the orbit, the nasal bone, and the posterior lateral wall of the orbit; 2) detachment of the medial canthal ligaments; and 3) spreading of the interocular distance. This approach provides a wide working space beneath the anterior half of the midline skull base, and needs neither a facial incision nor significant retraction of the brain. The surgical technique and its modification are described. The discussion focuses not only on comparisons with other techniques, but on the indications for this approach. Meningiomas originating in the paranasal sinuses are rare; a brief review of the literature concerning the clinicopathological features and pathogenesis is also given.
在3例累及筛窦和蝶窦的脑膜瘤病例中，采用经鼻基底撑开眼间距（远内眦入路）来切除肿瘤并重建颅底。这种远内眦入路包括：1）整块切除双侧眶上外侧缘、鼻骨和眶后外侧壁；2）分离内眦韧带；3）撑开眼间距。该入路可在中线颅底前半部分下方提供广阔的操作空间，既无需面部切口，也无需对脑进行大幅度牵拉。文中描述了手术技术及其改良方法。讨论不仅聚焦于与其他技术的比较，还涉及该入路的适应证。起源于鼻窦的脑膜瘤较为罕见；文中还对有关其临床病理特征和发病机制的文献进行了简要综述。
