Shibao Shunsuke, Toda Masahiro, Tomita Toshiki, Saito Katsuya, Ogawa Kaoru, Kawase Takeshi, Yoshida Kazunari
Department of Neurosurgery, Head, and Neck Surgery, Keio University Graduate School of Medicine.
Neurol Med Chir (Tokyo). 2015;55(4):351-5. doi: 10.2176/nmc.tn.2014-0254. Epub 2015 Mar 23.
Recently, petrous apex cholesterol granulomas (CGs) have been treated via the endoscopic endonasal transsphenoidal approach (EEA) using a silicone tube, to prevent drainage route occlusion. Occlusion of the drainage route has led to problems with recurrence. The aim of this report is to describe the use of a surgical technique to prevent drainage route occlusion. In surgical technique, the posterolateral wall of the sphenoid sinus was opened by EEA. After cyst debridement, a vascularized nasoseptal flap with a width of approximately 4 cm was inserted into the lumen with a silicone T-tube with a diameter of 7 mm. This technique was used in two patients: the first patient during the second operation after recurrence following occlusion of the drainage route, and the second patient during the first operation. Opening of the cyst wall was confirmed endoscopically in both patients 12-24 months after surgery, even after removal of the T-tube. In conclusion, the use of a pedicled nasoseptal flap with a silicone tube is useful to prevent CG recurrence, by paranasal cavitization of the cystic cavity.
最近，岩尖胆固醇肉芽肿（CGs）已通过鼻内镜经蝶入路（EEA）使用硅胶管进行治疗，以防止引流途径阻塞。引流途径的阻塞导致了复发问题。本报告的目的是描述一种防止引流途径阻塞的手术技术的应用。在手术技术中，通过EEA打开蝶窦后壁。囊肿清创后，将宽度约为4 cm的带血管鼻中隔瓣与直径7 mm的硅胶T形管一起插入管腔。该技术应用于两名患者：第一名患者在引流途径阻塞复发后的第二次手术中，第二名患者在第一次手术中。术后12 - 24个月，两名患者即使在拔除T形管后，通过内镜均确认囊肿壁已打开。总之，带蒂鼻中隔瓣联合硅胶管的应用通过使囊肿腔鼻窦化，有助于预防CG复发。
