Fujimoto Yasunori, Ramos Henrique F, Mariani Pedro P, Romano Fabrizio R, Cukiert Arthur, Bor-Seng-Shu Edson, Wakayama Akatsuki, Yoshimine Toshiki
Department of Neurosurgery, Osaka Neurological Institute.
Neurol Med Chir (Tokyo). 2015;55(4):345-50. doi: 10.2176/nmc.tn.2014-0159. Epub 2015 Mar 23.
We describe a practical technique of superior turbinectomy followed by posterior ethmoidectomy as a less invasive procedure for two-surgeon technique on endoscopic endonasal transsphenoidal surgery. After identification of the superior turbinate and the sphenoid ostium, the inferior third portion of the superior turbinate was coagulated and resected. This partial superior turbinectomy procedure exposed the posterior ethmoidal sinus. Resection of the bony walls between the sphenoid and posterior ethmoid sinuses provided more lateral and superior exposure of the sphenoid sinus. This technique was performed in 56 patients with midline skull base lesions, including 49 pituitary adenomas and 7 other lesions. Meticulous manipulation of instruments was performed in all cases without surgical complications such as permanent hyposmia/anosmia or nasal bleeding. Our findings suggested that the partial superior turbinectomy followed by retrograde posterior ethmoidectomy is a simple and safe technique providing a sufficient surgical corridor for two-surgeon technique to approaching midline skull base regions, mainly involving pituitary adenomas.
我们描述了一种实用技术，即先行上鼻甲切除术，再行后筛窦切除术，作为一种侵入性较小的双术者技术用于鼻内镜下经鼻蝶窦手术。在识别上鼻甲和蝶窦开口后，对上鼻甲下三分之一部分进行凝固和切除。这种部分上鼻甲切除术暴露了后筛窦。切除蝶窦和后筛窦之间的骨壁可提供蝶窦更外侧和上方的暴露。该技术应用于56例中线颅底病变患者，包括49例垂体腺瘤和7例其他病变。所有病例均进行了精细的器械操作，未出现诸如永久性嗅觉减退/嗅觉丧失或鼻出血等手术并发症。我们的研究结果表明，先行部分上鼻甲切除术，再行逆行后筛窦切除术是一种简单且安全的技术，可为双术者技术接近中线颅底区域（主要涉及垂体腺瘤）提供足够的手术通道。
