Harvey Richard J, Gallagher Richard M, Sacks Raymond
Rhinology and Skull Base Surgery, Department of Otolaryngology/Skull Base Surgery, St Vincent's Hospital, 354 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
Otolaryngol Clin North Am. 2010 Jun;43(3):613-38, x. doi: 10.1016/j.otc.2010.02.016.
The evolution of endoscopic sinus surgery has led to a paradigm shift in the management of sinonasal and anterior skull base tumors in the past decade. Endoscopic resection is considered by many institutions to be the gold standard approach even for extensive pathology. Endoscopic tumor surgery should not imply less surgery but rather an alternative to external operations providing the same access and enabling equivalent or superior visualization for resection of tumors. It also avoids much of the potentially significant morbidity associated with external operations. Successful endoscopic tumor resection requires experience, an understanding of tumor behavior, and the development of a unique skill set. Tumor removal is often performed inside-out. Regions such as the anterolateral maxilla and frontal sinus require special access. Orientation of the surgeon is different to that of simple inflammatory disease. A structured approach to vascular control is important to ensure a workable surgical field. The final cavity and reconstruction need to be fashioned to ensure that reasonable sinonasal physiology and function are retained, including the lacrimal apparatus. The endoscopic cavity created after extensive surgery requires different care compared with the mucosal-preserving techniques of inflammatory disease. This article describes these key methodological differences that enable extended endoscopic surgery of the sinonasal tract and anterior skull base.
在过去十年中，鼻内镜鼻窦手术的发展已使鼻窦和前颅底肿瘤的治疗模式发生了转变。许多机构认为，即使对于广泛的病变，内镜切除术也是金标准术式。内镜肿瘤手术并不意味着手术范围更小，而是一种替代外部手术的方法，它能提供相同的入路，并能在切除肿瘤时实现同等或更好的视野。它还能避免许多与外部手术相关的潜在严重并发症。成功的内镜肿瘤切除术需要经验、对肿瘤行为的了解以及一套独特技能的培养。肿瘤切除通常由内向外进行。上颌骨前外侧和额窦等区域需要特殊的入路。外科医生的手术方向与单纯炎症性疾病不同。采用结构化的血管控制方法对于确保可行的手术视野很重要。最终的术腔和重建需要精心设计，以确保保留合理的鼻窦生理功能，包括泪器。与炎症性疾病的保留黏膜技术相比，广泛手术后形成的内镜术腔需要不同的护理。本文描述了这些关键的方法学差异，这些差异使得鼻窦和前颅底的扩大内镜手术成为可能。
