Sanna Mario, Piazza Paolo, De Donato Giuseppe, Menozzi Roberto, Falcioni Maurizio
Gruppo Otologico Piacenza, Roma, Italy.
Skull Base. 2009 Jan;19(1):26-42. doi: 10.1055/s-0028-1103126.
The infratemporal fossa approach described by Fisch overcame most of the factors that had previously prevented the total removal of tympanojugular paragangliomas (TJP). The remaining problem has been infiltration of the internal carotid artery (ICA) for which there has been no entirely satisfactory solution. At the least, severe encasement risks the possibility of an arterial rupture at surgery. In order to reduce this risk, preoperative endovascular interventions have been employed-mainly balloon occlusion, with or without arterial bypass. Recently, intra-arterial stents to reinforce the encased segment of the ICA have been introduced. This study evaluates our experience with 20 patients affected by TJP in which the ICA has been subjected to preoperative interventions. Ten patients underwent a preoperative balloon occlusion and the other 10 patients had their ICAs reinforced with stents. Problems that arose during embolization necessitated that one patient with a stent required ligation of their ICA. No other problems were encountered during endovascular treatment or surgical resection. In one patient with a stent, it was impossible to establish a cleavage plane between their recurrent tumour and the ICA. These early results are encouraging and suggest that intra-arterial stents have a part to play in the surgical management of large TJPs.
菲施描述的颞下窝入路克服了此前阻碍鼓室颈静脉副神经节瘤（TJP）全切的大多数因素。剩下的问题是颈内动脉（ICA）受侵，对此尚无完全令人满意的解决方案。至少，严重包绕会使手术中动脉破裂的可能性增加。为降低此风险，已采用术前血管内干预措施——主要是球囊闭塞，有或没有动脉搭桥。最近，已引入动脉内支架来加固ICA的受包绕段。本研究评估了我们对20例受TJP影响且ICA接受了术前干预的患者的经验。10例患者接受了术前球囊闭塞，另外10例患者的ICA用支架进行了加固。栓塞过程中出现的问题使得1例置入支架的患者需要结扎其ICA。血管内治疗或手术切除过程中未遇到其他问题。在1例置入支架的患者中，无法在其复发性肿瘤与ICA之间建立分离平面。这些早期结果令人鼓舞，表明动脉内支架在大型TJP的手术治疗中可发挥作用。
