Chung Hyo Jin, Moon In Seok, Cho Hyung-Ju, Kim Chang-Hoon, Sharhan Salma Saud Al, Chang Jung Hyun, Yoon Joo-Heon
Department of Otorhinolaryngology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Craniofac Surg. 2019 Mar/Apr;30(2):589-595. doi: 10.1097/SCS.0000000000005108.
Selecting an appropriate surgical approach for resection of huge skull base tumors involving pterygopalatine and infratemporal fossa is challenging because of their rarity and high possibility of vital anatomical structure injuries. To suggest the guidance of selecting the appropriate approach by analyzing outcomes and satisfactions of known surgical approaches with our previous experience, the authors retrospectively analyzed skull base tumor cases experienced for 24 years, and condensed to 4 well-known surgical approaches: maxillary swing, infratemporal fossa type C, transzygomatic, and a combined transzygomatic-midfacial degloving approach: to review indications, advantages, and limitations of these approaches. Maxillary swing approach was useful in large-sized tumors as it provided wide surgical field; however, inevitable facial scar was the main drawbacks, especially in adolescents. Infratemporal fossa approach type C was helpful in the involvement of vital vascular structures; however, long incision scar with temporal area depression and permanent conductive hearing loss were the factors of patients' dissatisfaction. Transzygomatic approach could be the good alternative to the infratemporal fossa approach type C; however, en bloc tumor resection was impossible due to its limited operative space. To overcome limitations of these approaches, transzygomatic approach was combined with midfacial degloving approach, and it enabled lateral and anterior access without prominent facial scar and/or deformity while providing wide surgical space. Based on our 24 years of surgical experience in managing huge skull base tumors, the authors recommend the combined transzygomatic-midfacial degloving approach, which enables complete resection with short postoperative healing periods and no disfiguring facial incisions.
对于涉及翼腭窝和颞下窝的巨大颅底肿瘤，选择合适的手术入路进行切除具有挑战性，因为此类肿瘤罕见且重要解剖结构损伤的可能性高。为了根据已知手术入路的结果和满意度以及我们之前的经验，为选择合适的入路提供指导，作者回顾性分析了24年中所经历的颅底肿瘤病例，并归纳为4种知名的手术入路：上颌骨摆动术、C型颞下窝入路、经颧弓入路以及经颧弓-面中部掀翻联合入路，以审视这些入路的适应症、优点和局限性。上颌骨摆动术适用于大型肿瘤，因为它能提供广阔的手术视野；然而，不可避免的面部瘢痕是主要缺点，尤其是在青少年患者中。C型颞下窝入路有助于处理涉及重要血管结构的情况；然而，较长的切口瘢痕、颞部区域凹陷和永久性传导性听力丧失是患者不满意的因素。经颧弓入路可能是C型颞下窝入路的良好替代方案；然而，由于其手术空间有限，无法整块切除肿瘤。为了克服这些入路的局限性，将经颧弓入路与面中部掀翻入路相结合，它能够在不产生明显面部瘢痕和/或畸形的情况下实现外侧和前方入路，同时提供广阔的手术空间。基于我们24年处理巨大颅底肿瘤的手术经验，作者推荐经颧弓-面中部掀翻联合入路，该入路能够实现完整切除，术后愈合期短且面部切口无毁容。
