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经鼻内镜治疗复发性岩尖胆固醇肉芽肿

Endoscopic endonasal management of recurrent petrous apex cholesterol granuloma.

作者信息

McLaughlin Nancy, Kelly Daniel F, Prevedello Daniel M, Shahlaie Kiarash, Carrau Ricardo L, Kassam Amin B

机构信息

Brain Tumor Center, John Wayne Cancer Institute of Saint John's Health Center, Santa Monica, California, United States.

出版信息

J Neurol Surg B Skull Base. 2012 Jun;73(3):190-6. doi: 10.1055/s-0032-1312706.

Abstract

Introduction Petrous apex cholesterol granulomas (PACGs) are uncommon lesions. Recurrence following transcranial or endonasal approaches to aerate the cyst occurs in up to 60% of cases. We describe the technical nuances pertinent to the endonasal endoscopic management of a recurrent symptomatic PACG and review the literature. Results A 19-year-old woman presented with a recurrent abducens nerve paresis. Four months prior, she underwent an endonasal transsphenoidal surgery (TSS) for drainage of a symptomatic PACG. Current imaging documented recurrence of the right PACG. Transsphenoidal and infrapetrous approaches were performed to obtain a wider bony opening along the petrous apex and drain the cyst. A Doyle splint was inserted into the cyst's cavity and extended out into the sphenoid sinus, maintaining patency during the healing process. Three months after surgery, the splint was removed endoscopically, allowing visualization of a patent cylindrical communication between both aerated cavities. The patient remains symptom-free and recurrence-free. Conclusion Endoscopic endonasal surgery must be adapted to manage a recurrent PACG. A TSS may not be sufficient. An infrapetrous approach with wider bony opening, extensive removal of the cyst's anterior wall, and the use of a stent are indicated for the treatment of recurrent PACG and to prevent recurrences.

摘要

引言 岩尖胆固醇肉芽肿(PACG)是一种罕见病变。经颅或经鼻入路对囊肿进行通气后,复发率高达60%。我们描述了复发性有症状PACG的鼻内镜治疗相关技术细节并回顾相关文献。结果 一名19岁女性因复发性展神经麻痹就诊。4个月前,她因有症状的PACG接受了鼻内镜下经蝶窦手术(TSS)引流。目前影像学检查显示右侧PACG复发。采用经蝶窦和岩下入路以在岩尖获得更宽的骨性开口并引流囊肿。将一个多伊尔夹板插入囊肿腔并延伸至蝶窦,在愈合过程中保持通畅。术后3个月,在内镜下取出夹板,可见两个通气腔之间有一个通畅的圆柱形通道。患者无症状且未复发。结论 鼻内镜手术必须进行调整以处理复发性PACG。TSS可能并不充分。对于复发性PACG的治疗及预防复发,采用岩下入路以获得更宽的骨性开口、广泛切除囊肿前壁并使用支架是必要的。

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Petrous apex cholesterol granuloma treated via the endoscopic transsphenoidal approach.
Acta Neurochir (Wien). 2007 Mar;149(3):299-302; discussion 302. doi: 10.1007/s00701-006-1105-x. Epub 2007 Feb 2.
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Petrous apex cholesterol granuloma: transsphenoid endoscopic approach.岩尖胆固醇肉芽肿:经蝶窦内镜入路
J Laryngol Otol. 2006 Jun;120(6):e20. doi: 10.1017/S0022215106009121. Epub 2006 May 15.
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Endoscopy-assisted surgery of the petrous apex.岩尖的内镜辅助手术
Otolaryngol Head Neck Surg. 2004 Feb;130(2):229-41. doi: 10.1016/j.otohns.2003.11.002.
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Surgical management of petrous apex cholesterol granulomas.岩尖胆固醇肉芽肿的外科治疗
Otol Neurotol. 2002 Jul;23(4):529-33. doi: 10.1097/00129492-200207000-00023.

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