Lubbe Darlene E, Douglas-Jones Paul, Wasl Hisham, Mustak Hamzah, Semple Patrick L
Division of Otorhinolaryngology, University of Cape Town, Cape Town, South Africa.
Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
Ear Nose Throat J. 2020 Jan;99(1):62-67. doi: 10.1177/0145561319846828. Epub 2019 Apr 24.
Conventional surgical approaches to the lateral aspect of a well-pneumatized sphenoid sinus are associated with significant surgical morbidity. Transorbital endoscopic approaches have recently gained favor as an alternative approach to the skull base. We describe the use of a contralateral precaruncular endoscopic approach to provide a surgical pathway to the lateral aspect of the sphenoid sinus, allowing for improved and direct visualization of the surgical field, with limited morbidity.
A 60-year-old female patient, with a spontaneous cerebrospinal fluid leak from a Sternberg canal defect in the sphenoid sinus, underwent repair of the defect at Groote Schuur Hospital (Cape Town, South Africa). A contralateral precaruncular approach, using the left medial orbital portal, was utilized to access the defect in the lateral aspect of a well-pneumatized right sphenoid sinus. Computer modeling software was used to predetermine the surgical pathway, and the case was performed under navigation guidance. Adequate surgical access was obtained to the lateral sphenoid sinus and sinus defect, with superior visualization compared to a pure transnasal or transpterygoid approach to the lateral sphenoid sinus.
This case validates the use of computer simulation to plan and decide on the best operative approaches in skull base surgery and describes the contralateral precaruncular approach as a surgical pathway to the lateral sphenoid sinus. Advantages of the contralateral precaruncular approach include a direct trajectory toward the sinus defect, easy access with a standard 18-cm, 4-mm, 0-degree rigid endoscope, and straight instruments, with sparing of the pterygoid base and contents of the pterygopalatine fossa.
传统的手术方法治疗气化良好的蝶窦外侧病变会导致显著的手术并发症。经眶内镜手术作为一种替代的颅底手术方法，近来受到青睐。我们描述了一种对侧泪阜前内镜入路，用于为蝶窦外侧提供手术路径，可改善并直接观察手术视野，且并发症有限。
一名60岁女性患者，因蝶窦斯滕伯格管缺损导致自发性脑脊液漏，在南非开普敦的格罗特舒尔医院接受缺损修复手术。采用对侧泪阜前入路，通过左侧眶内侧入口，进入气化良好的右侧蝶窦外侧的缺损处。使用计算机建模软件预先确定手术路径，并在导航引导下进行手术。与单纯经鼻或经翼突入路相比，该入路能更好地显露蝶窦外侧及窦缺损处。
本病例验证了计算机模拟在颅底手术中规划和确定最佳手术入路的应用，并描述了对侧泪阜前入路作为蝶窦外侧的手术路径。对侧泪阜前入路的优点包括：直接通向窦缺损的路径、使用标准的18厘米、4毫米、0度硬性内镜及直器械易于进入、保留翼突基部及翼腭窝内容物。
