Matsuda Tatsuma, Horiguchi Kentaro, Higuchi Yoshinori, Hanazawa Toyoyuki, Okamoto Yoshitaka, Iwadate Yasuo
Department of Neurosurgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of Otorhinolaryngology-Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Laryngoscope. 2018 Aug;128(8):1798-1801. doi: 10.1002/lary.27060. Epub 2017 Dec 27.
Tension pneumosella (TP) is a rare entity reported as the invagination of the sphenoid sinus mucosa into the skull base after endonasal transsphenoidal surgery. Few studies have reported on TP, and in these studies, invagination is confined to either the intrasellar or suprasellar area. We encountered a case of unexpected prominent TP toward the intracranial space 5 years after endoscopic endonasal transsphenoidal surgery (EETS) for a nonfunctioning pituitary adenoma. In addition, we present a hypothesis of the underlying mechanism by a pressure gradient change between the extracranial and intracranial space in TP formation. For repair, a pedicled nasal septal flap was fabricated from the remaining part of the septal mucosa, and a pedicled inferior turbinate flap was created. Moreover, the nasal septal cartilage was used as a rigid support for reconstruction, which was useful for preventing TP recurrence. This is the first report of an unexpected prominent TP after EETS. It is important for otorhinolaryngologists and neurosurgeons to be aware of the possibility of TP following EETS. Laryngoscope, 1798-1801, 2018.
张力性蝶窦气囊肿（TP）是一种罕见的病变，据报道是在鼻内镜经蝶窦手术后蝶窦黏膜向颅底内陷形成。关于TP的研究较少，且在这些研究中，内陷局限于鞍内或鞍上区域。我们遇到一例在因无功能垂体腺瘤接受鼻内镜下经蝶窦手术（EETS）5年后出现的、向颅内空间突出的意外显著的TP病例。此外，我们提出了一种关于TP形成过程中颅外和颅内空间压力梯度变化的潜在机制假说。为了修复，我们从鼻中隔黏膜的剩余部分制作了带蒂鼻中隔瓣，并制作了带蒂下鼻甲瓣。此外，鼻中隔软骨被用作重建的刚性支撑，这对于预防TP复发很有用。这是关于EETS后出现意外显著TP的首例报告。耳鼻咽喉科医生和神经外科医生意识到EETS后发生TP的可能性很重要。《喉镜》，2018年，第1798 - 1801页。
