Majmundar Neil, Kamal Naveed H, Reddy Renuka K, Eloy Jean A, Liu James K
Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Department of Otolaryngology, Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
J Neurosurg Sci. 2018 Jun;62(3):287-296. doi: 10.23736/S0390-5616.18.04348-5. Epub 2018 Feb 13.
The endoscopic endonasal transcribriform approach (EETA) has become a useful strategy in the treatment of various anterior skull base pathologies, including meningoencephaloceles, olfactory groove meningiomas, schwannomas, esthesioneuroblastomas, and other sinonasal malignancies. However, not all pathologies are optimally treated through this approach due to tumor size, extent of the lesion, vascular involvement, and the presence of intact olfaction. One must be prepared to use a transcranial approach if the EETA is not favorable. In some patients, a combined approach (transcranial-EETA) may be needed in appropriate cases. Therefore, patient selection is paramount for achieving a successful result with avoidance of complications. For certain tumors, the limitations of the EETA may result in lower rates of gross-total resection, higher rates of cerebrospinal fluid leakage, postoperative impairment of olfaction, and higher complication rates. In this paper, we discuss the limitations of the EETA when considering approach selection to treat anterior skull base lesions.
鼻内镜经筛板入路（EETA）已成为治疗各种前颅底病变的一种有效策略，这些病变包括脑膜脑膨出、嗅沟脑膜瘤、神经鞘瘤、嗅神经母细胞瘤以及其他鼻窦恶性肿瘤。然而，由于肿瘤大小、病变范围、血管受累情况以及嗅觉是否完整，并非所有病变都能通过该入路得到最佳治疗。如果EETA不可行，必须准备好采用经颅入路。在某些患者中，适当情况下可能需要联合入路（经颅 - EETA）。因此，患者选择对于取得成功结果并避免并发症至关重要。对于某些肿瘤，EETA的局限性可能导致全切除率较低、脑脊液漏发生率较高、术后嗅觉障碍以及并发症发生率较高。在本文中，我们讨论在考虑选择治疗前颅底病变的入路时EETA的局限性。
