Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Department of Neurosurgery, Peking University First Hospital, Beijing 100034, China.
Chin Med J (Engl). 2019 Apr 5;132(7):798-804. doi: 10.1097/CM9.0000000000000142.
The endoscopic transnasal approach has been proven to have advantages on the removal of the tumors in pterygopalatine fossa (PPF) and infratemporal fossa (ITF). Herein, this study aimed to describe a modified approach for resection of the tumors in these areas, both in cadaveric specimen and clinical patients.
The 20 adult cadaveric specimens and five patients with tumors in PPF and ITF were enrolled in this study. For the cadaveric specimens, ten were simulated anterior transmaxillary approach and ten were performed modified endoscopic transnasal transmaxillary approach. The exposure areas were compared between two groups and main anatomic structure were measured. Surgery was operated in the five patients with tumors of PPF and ITF to verify the experience from the anatomy. Perioperative management, intraoperative findings and postoperative complications were recorded and analyzed.
The modified endoscopic transnasal transmaxillary approach provided as enough surgical exposure and high operability to the PPF and ITF as the anterior transmaxillary approach did. The diameter of maxillary artery in the PPF was 3.77 ± 0.78 mm (range: 2.06-4.82 mm), the diameter of middle meningeal artery in the ITF was 2.79 ± 0.61 mm (range: 1.54-3.78 mm). Four patients who suffered schwannoma got total removal and one of adenocystic carcinoma got subtotal removal. The main complications were facial numbness and pericoronitis of the wisdom tooth. No permanent complication was found.
With the widespread use of neuroendoscopy, the modified endoscopic transnasal transmaxillary approach is feasible and effective for the resection of tumors located in PPF and ITF, which has significant advantages on less trauma and complications to the patients.
经鼻内镜入路已被证明在切除翼腭窝（PPF）和颞下窝（ITF）肿瘤方面具有优势。在此，本研究旨在描述一种改良的方法，用于切除这些区域的肿瘤，包括在尸体标本和临床患者中。
本研究纳入了 20 具成人尸体标本和 5 例 PPF 和 ITF 肿瘤患者。对于尸体标本，10 例模拟经前上颌窦入路，10 例采用改良经鼻内镜经上颌窦入路。比较两组暴露面积，测量主要解剖结构。对 5 例 PPF 和 ITF 肿瘤患者进行手术，验证解剖学经验。记录和分析围手术期管理、术中发现和术后并发症。
改良经鼻内镜经上颌窦入路为 PPF 和 ITF 提供了与经前上颌窦入路相同的足够手术暴露和高操作性。PPF 中上颌动脉直径为 3.77±0.78mm（范围：2.06-4.82mm），ITF 中脑膜中动脉直径为 2.79±0.61mm（范围：1.54-3.78mm）。4 例神经鞘瘤患者均获得全切，1 例腺泡状腺癌患者获得次全切。主要并发症为面部麻木和智齿冠周炎。无永久性并发症。
随着神经内镜的广泛应用，改良经鼻内镜经上颌窦入路对于切除 PPF 和 ITF 部位的肿瘤是可行和有效的，与传统方法相比，对患者的创伤和并发症更小。
