Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
Laryngoscope. 2010 Dec;120(12):2360-6. doi: 10.1002/lary.21153.
To evaluate the benefits of middle turbinectomy on the exposure of the skull base structures.
An anatomical study on 20 fresh cadaver heads.
The extent of the exposure of the skull base structures during endoscopic endonasal approach has not been addressed specifically in respect to the whether or not the middle turbinectomy is performed. We compared the extent of exposure obtained by endonasal transsphenoidal approaches without middle turbinectomy (NMT), with unilateral turbinectomy (UMT), and with bilateral turbinectomy (BMT). Our preselected target points in the skull base consisted of sella turcica, tuberculum sella, planum sphenoidale, clivus (upper and middle third), and ipsilateral sphenopalatine artery (SPA).
Of our preselected anatomic target points, only the middle third of the clivus and ipsilateral SPA had enhanced exposure in UMT (100% for both structures) compared to NMT (45% and 20%, respectively). The addition of a BMT did not provide added exposure to any target compared with a UMT.
Middle turbinectomy may not be necessary for endonasal transsphenoidal approach to the lesions of the sella, planum sphenoidale, and upper third of the clivus. However, gaining access to the middle clival region is facilitated by resection of middle turbinate.
评估中鼻甲切除术对颅底结构暴露的益处。
在 20 个新鲜头颅标本上进行的解剖学研究。
在经鼻内镜颅底入路中，尚未专门针对是否进行中鼻甲切除术来评估对颅底结构暴露的程度。我们比较了未行中鼻甲切除术（NMT）、单侧鼻甲切除术（UMT）和双侧鼻甲切除术（BMT）的经鼻内镜经蝶窦入路获得的暴露程度。我们在颅底预选的目标点包括蝶鞍、鞍结节、蝶骨体、斜坡（中上 1/3）和同侧蝶腭动脉（SPA）。
在我们预选的解剖学目标点中，只有中鼻甲切除术（UMT）可使斜坡中上 1/3 和同侧 SPA 的暴露明显增加（两者均为 100%），而 NMT 的暴露程度分别为 45%和 20%。与 UMT 相比，行 BMT 并不能使任何目标的暴露程度增加。
对于鞍内、蝶骨体和斜坡中上 1/3 的病变，行中鼻甲切除术可能不是经鼻内镜经蝶窦入路所必需的。然而，切除中鼻甲有助于进入中斜坡区域。
