Palejwala Sheri K, Zhao Fan, Lanker Kayla C, Sivakumar Walavan, Takasumi Yuki, Griffiths Chester F, Barkhoudarian Garni, Kelly Daniel F
Pacific Neuroscience Institute, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, USA.
Pacific Neuroscience Institute, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, USA; Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
World Neurosurg. 2018 Oct;118:e346-e355. doi: 10.1016/j.wneu.2018.06.190. Epub 2018 Jun 30.
Meckel's cave is a dural-lined cavity in the middle fossa skull base in which lies the Gasserian ganglion, a potential site for tumors and inflammatory lesions. A variety of lesions can be predominantly isolated to Meckel's cave, including extension from head and neck cancers, other malignant tumors, as well as benign lesions. Clinical presentation and imaging findings are often insufficient to establish a diagnosis. Hence, histologic confirmation is required to determine the appropriate treatment strategy. Several surgical approaches have been used to reach this deep-seated area, often with significant morbidity and prolonged recovery. Given advancements in endoscopy and greater facility with the technique, the endoscopic endonasal approach has been used increasingly to reach lesions in the region.
A single-institution, retrospective chart review over a 10-year period was performed to identify and describe patients with pathologically differing but imaging-similar lesions with their epicenter in Meckel's cave.
Of a total of 21 cases of lesions in Meckel's cave approached by an endoscopic endonasal transpterygoid approach, we present 6 patients with imaging-ambiguous lesions involving Meckel's cave that were biopsied via the extended endoscopic endonasal approach. Among this diverse group, pathology included B-cell lymphoma, squamous cell carcinoma, adenocarcinoma, malignant schwannoma, benign schwannoma, and neurosarcoidosis.
We explore not only the relevance of this approach in the armamentarium of the modern skull-base surgeon but also its limitations and conclude that the endoscopic endonasal approach provides a safe and relatively direct, minimally invasive corridor to many lesions of Meckel's cave.
梅克尔腔是位于中颅窝颅底的硬脑膜内衬腔隙，三叉神经节位于其中，是肿瘤和炎性病变的潜在发生部位。多种病变可主要局限于梅克尔腔，包括头颈部癌症、其他恶性肿瘤以及良性病变的蔓延。临床表现和影像学表现往往不足以确诊。因此，需要组织学确认来确定合适的治疗策略。已经采用了几种手术入路来到达这个深部区域，通常会有较高的发病率和较长的恢复时间。鉴于内镜技术的进步以及对该技术的更熟练掌握，内镜鼻内入路越来越多地用于到达该区域的病变。
进行了一项单机构、为期10年的回顾性病历审查，以识别和描述病变病理不同但影像学相似且以梅克尔腔为中心的患者。
在内镜鼻内经翼突入路治疗的21例梅克尔腔病变中，我们展示了6例通过扩大内镜鼻内入路活检的梅克尔腔影像不明确病变患者。在这一多样的病例组中，病理包括B细胞淋巴瘤、鳞状细胞癌、腺癌、恶性神经鞘瘤、良性神经鞘瘤和神经结节病。
我们不仅探讨了这种入路在现代颅底外科医生手术方法中的相关性，还探讨了其局限性，并得出结论，内镜鼻内入路为许多梅克尔腔病变提供了一条安全、相对直接的微创通道。
