Wigand Malte Erik, Iro Heinrich, Bozzato Alessandro
Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, FAU Medical School, Erlangen, Germany.
Skull Base. 2009 Mar;19(2):151-8. doi: 10.1055/s-0028-1096200.
Various transcranial and transfacial approaches have been described and each claims to provide the best exposure to the anterior skull base. Similarly, each approach claims the best outcomes following the resection of anterior skull base malignancies. We have always advocated a combined neurorhinological approach for the management of paranasal sinus malignancies that infiltrate the skull base, such as esthesioneuroblastomas.
At the outset, the technique was developed on cadaver specimens, imitating the limitations that might be imposed in the real-life situation when undertaking endoscopic sinus surgery. Additional exposure of the anterior cerebral fossa was achieved using a classical bifrontal approach. Starting with endoscopic or microscopic unroofing of the ethmoids, all relevant landmarks were identified. The frontal, sphenoid, and maxillary sinuses were then opened using endoscopic techniques.
The dissections proved that a broad exposure of the anterior skull base could be combined with clear endoscopic visualization of the nasal cavity and of all the paranasal sinuses from above. This facilitated complete eradication of lesions from the sinuses cavities, their walls, and the intracranial tumor.
The combined neurorhinosurgical transcranial approach to the anterior skull base and nasal and paranasal sinuses, avoiding trans-facial approaches, enables a multidiciplinary team to resect malignant tumors of the anterior skull base directly without unnecessary destruction of facial structures. It appears to provide better access than other more destructive methods like midfacial degloving or subfrontal approaches. Our single-stage approach also facilitates safe and effective reconstruction of the skull base. The technique can be employed for tumors of all sizes and is also used for orbital resections and decompression of the optic nerve and chiasma.
已经描述了多种经颅和经面入路，每种入路都声称能提供对前颅底的最佳暴露。同样，每种入路都声称在切除前颅底恶性肿瘤后能取得最佳效果。我们一直主张采用神经鼻科联合入路来治疗侵犯颅底的鼻窦恶性肿瘤，如嗅神经母细胞瘤。
一开始，该技术是在尸体标本上开发的，模拟了在进行鼻内镜鼻窦手术时现实情况中可能存在的限制。使用经典的双额入路实现对前颅窝的额外暴露。从鼻内镜或显微镜下打开筛窦开始，识别所有相关标志。然后使用鼻内镜技术打开额窦、蝶窦和上颌窦。
解剖证明，前颅底的广泛暴露可以与从上方清晰的鼻内镜观察鼻腔和所有鼻窦相结合。这有助于彻底清除鼻窦腔、其壁以及颅内肿瘤的病变。
联合神经鼻科经颅入路治疗前颅底及鼻腔和鼻窦，避免经面入路，使多学科团队能够直接切除前颅底恶性肿瘤，而无需对面部结构进行不必要的破坏。它似乎比其他更具破坏性的方法，如面中部掀翻术或额下入路，提供了更好的入路。我们的单阶段入路也便于安全有效地重建颅底。该技术可用于各种大小的肿瘤，也用于眼眶切除以及视神经和视交叉减压。
