Eördögh Márton, Briner Hans Rudolf, Simmen Daniel, Jones Nicholas, Reisch Robert
Department of Neurosurgery KRH Klinikum Nordstadt Hannover Germany.
Center for Otorhinolaryngology, Head and Neck Surgery, Hirslanden Clinic Zurich Switzerland.
Laryngoscope Investig Otolaryngol. 2017 May 28;2(5):281-287. doi: 10.1002/lio2.82. eCollection 2017 Oct.
The endoscopic technique in transnasal skull base surgery offers optimal visualization and free manipulation in the surgical field. However, it may cause approach-related sinonasal injury, influencing patients' quality of life (QOL). To minimize rhinological morbidity without restrictions in surgical manipulation and tumor resection, we introduced the unilateral transethmoidal-paraseptal approach. In this article, we analyzed the long-term results and sinonasal outcome of this technique.
Retrospective analysis of medical records.
Forty-two consecutive patients underwent surgery between June 2010 and March 2014 using the transethmoid-paraseptal approach. Perioperative work-up included neurological, radiological, endocrinological, ophthalmological, and rhinological analysis. Patients' preoperative, 1-month and 1-year postoperative QOL was measured using the Sino-Nasal Outcome Test (SNOT-22).
At all individuals, a unilateral transethmoid-paraseptal approach was performed. Removal of the turbinates, posterior septal resection or a conversion to biportal surgery could be avoided in all cases. There were no intraoperative neurovascular complications. All patients had a notable improvement in any disease-related symptoms, as well as by objective criteria. Complete tumor resection was aimed in 39 cases and achieved in 31 of them. The SNOT-22 scores transiently worsened 1 month after surgery and non-significantly improved after 1 year, compared with the preoperative status. A subgroup of 7 patients with preoperative sinonasal disease evidence showed continuous significant improvement (p < .05) of SNOT-22 scores across time. The smell screening tests showed no significant difference across time.
The described approach allows safe removal of various skull base lesions without deterioration in sinonasal QOL and smell function.
经鼻颅底手术中的内镜技术可在手术视野中提供最佳的可视化效果和自由操作空间。然而，它可能会导致与手术入路相关的鼻窦损伤，影响患者的生活质量（QOL）。为了在不限制手术操作和肿瘤切除的情况下将鼻科发病率降至最低，我们引入了单侧经筛窦 - 鼻中隔旁入路。在本文中，我们分析了该技术的长期结果和鼻窦结局。
对病历进行回顾性分析。
2010年6月至2014年3月期间，连续42例患者采用经筛窦 - 鼻中隔旁入路进行手术。围手术期检查包括神经学、放射学、内分泌学、眼科学和鼻科学分析。使用鼻窦结局测试（SNOT - 22）测量患者术前、术后1个月和1年的生活质量。
所有患者均采用单侧经筛窦 - 鼻中隔旁入路。所有病例均避免了鼻甲切除、后鼻中隔切除或转为双门手术。术中无神经血管并发症。所有患者在任何疾病相关症状以及客观标准方面均有显著改善。39例患者旨在实现肿瘤完全切除，其中31例实现了完全切除。与术前状态相比，SNOT - 22评分在术后1个月短暂恶化，1年后无显著改善。7例术前有鼻窦疾病证据的患者亚组显示，SNOT - 22评分随时间持续显著改善（p < 0.05）。嗅觉筛查测试随时间无显著差异。
所述入路可安全切除各种颅底病变，而不会使鼻窦生活质量和嗅觉功能恶化。
4级。
