Turan Nefize, Baum Griffin R, Holland Christopher M, Ahmad Faiz U, Henriquez Oswaldo A, Pradilla Gustavo
Emory University School of Medicine, Department of Neurosurgery, Atlanta, GA, United States.
Emory University School of Medicine, Department of Otolaryngology, Head and Neck Surgery, Atlanta, GA, United States.
J Neurol Surg Rep. 2016 Mar;77(1):e017-22. doi: 10.1055/s-0035-1567865. Epub 2015 Nov 16.
Background Cholesterol granulomas arising at the petrous apex can be treated via traditional open surgical, endoscopic, and endoscopic-assisted approaches. Endoscopic approaches require access to the sphenoid sinus, which is technically challenging in patients with conchal sphenoidal anatomy. Clinical Presentation A 55-year-old woman presented with intermittent headaches and tinnitus. Formal audiometry demonstrated moderately severe bilateral hearing loss. CT of the temporal bones and sella revealed a well-demarcated expansile lytic mass. MRI of the face, orbit, and neck showed a right petrous apex mass measuring 22 × 18 × 19 mm that was hyperintense on T1- and T2-weighted images without enhancement, consistent with a cholesterol granuloma. The patient had a conchal sphenoidal anatomy. Operative Technique Herein, we present an illustrative case of a low-lying petroclival cholesterol granuloma in a patient with conchal sphenoidal anatomy to describe an alternative high nasopharyngeal corridor for endoscopic transnasal transclival access. Postoperative Course Postoperatively, the patient's symptoms recovered and no complications occurred. Follow-up imaging demonstrated a patent drainage tract without evidence of recurrence. Conclusion In patients with a conchal sphenoid sinus, endoscopic transnasal transclival access can be gained using a high nasopharyngeal approach. This corridor facilitates safe access to these lesions and others in this location.
背景 岩尖部出现的胆固醇肉芽肿可通过传统开放手术、内镜及内镜辅助方法进行治疗。内镜方法需要进入蝶窦，对于具有鼻甲蝶窦解剖结构的患者来说，这在技术上具有挑战性。临床表现 一名55岁女性出现间歇性头痛和耳鸣。正规听力测试显示双侧中度重度听力损失。颞骨和蝶鞍的CT显示一个边界清晰的膨胀性溶骨性肿块。面部、眼眶和颈部的MRI显示右侧岩尖部有一个大小为22×18×19mm的肿块，在T1加权和T2加权图像上呈高信号，无强化，符合胆固醇肉芽肿表现。该患者具有鼻甲蝶窦解剖结构。手术技术 在此，我们展示一例具有鼻甲蝶窦解剖结构患者的低位岩斜区胆固醇肉芽肿病例，以描述一种用于内镜经鼻经斜坡入路的替代性高鼻咽通道。术后过程 术后，患者症状恢复，未发生并发症。随访影像学检查显示引流道通畅，无复发迹象。结论 对于具有鼻甲蝶窦的患者，可采用高鼻咽入路获得内镜经鼻经斜坡入路。该通道有助于安全进入此部位的这些病变及其他病变。
