Alimohamadi Maysam, Hajiabadi Mohamadreza, Gerganov Venelin, Fahlbusch Rudolf, Samii Madjid
International Neuroscience Institute, Rudolf Pichlmayr Street, No. 4, 30625, Hannover, Germany,
Acta Neurochir (Wien). 2015 Jun;157(6):919-29; discussion 929. doi: 10.1007/s00701-015-2402-z. Epub 2015 Apr 7.
The pterygopalatine fossa (PPF) and inferomedial orbital apex are difficult regions for open neurosurgical access. The traditional extensive anterior approach (transfacial or transmandibular) and lateral/posterolateral (transcranial) approach were used to access the PPF. The combined endonasal and sublabial transmaxillary approach is a less invasive access route for these lesions. In this study, we present the technical and clinical details of our experience with the combined endoscopic endonasal and transmaxillary approach.
A retrospective analysis of our patients operated on using a combined endoscopic endonasal and transmaxillary approach was done. The preoperative, intraoperative and postoperative images and all the clinical data were evaluated. The accessibility to the area and extent of surgical resection were reviewed. The surgery-related complications and postoperative morbidities were analyzed. The main items of interest were the exposure of the target area and possibility for safe removal.
Five patients with pathologies located in the area of the PPF and orbital apex were operated on using the combined endoscopic sublabial and endonasal transmaxillary approach. The technique provided sufficient exposure of the area and allowed for safe removal of the preoperatively determined target in all of the patients. One patient developed dry eye and a neurotrophic corneal ulcer, and another patient developed temporary postoperative facial numbness. In the follow-up, only one patient with skull base chordoma had an asymptomatic tumor regrowth. The other patients had no recurrence or regrowth.
The combined endoscopic sublabial and endonasal transmaxillary approach is a safe and effective method for resection of lesions in the PPF and inferomedial orbital apex.
翼腭窝（PPF）和眶尖内侧是开放神经外科手术难以到达的区域。传统的广泛前路（经面或经下颌）和外侧/后外侧（经颅）入路用于进入翼腭窝。经鼻和唇下联合经上颌入路是这些病变侵入性较小的手术入路。在本研究中，我们介绍了经鼻内镜和经上颌联合入路的技术及临床经验细节。
对采用经鼻内镜和经上颌联合入路手术的患者进行回顾性分析。评估术前、术中和术后图像及所有临床数据。回顾手术区域的可达性及手术切除范围。分析手术相关并发症及术后发病率。主要关注的项目是目标区域的暴露情况及安全切除的可能性。
5例病变位于翼腭窝和眶尖区域的患者采用唇下内镜和经鼻联合经上颌入路进行手术。该技术能充分暴露手术区域，所有患者均能安全切除术前确定的目标病灶。1例患者出现干眼和神经营养性角膜溃疡，另1例患者术后出现暂时性面部麻木。随访期间，仅1例颅底脊索瘤患者肿瘤无症状复发。其他患者无复发或再生长。
唇下内镜和经鼻联合经上颌入路是切除翼腭窝和眶尖内侧病变的一种安全有效的方法。
