Department of Neurosurgery, Kobe University Graduate School of Medicine.
Department of Neurosurgery, Osaka University Graduate School of Medicine.
Neurol Med Chir (Tokyo). 2020 Jun 15;60(6):299-306. doi: 10.2176/nmc.oa.2020-0034. Epub 2020 May 14.
The nasal cavity is the exclusive surgical corridor for endoscopic endonasal surgery; however, it is sometimes too narrow to allow extensive surgical maneuvering. Here we show the technique of submucosal inferior turbinectomy (SIT) to widen this surgical corridor. Its effectiveness is evaluated quantitatively by comparing pre- and intraoperative magnetic resonance images. Between March 2015 and October 2018, we performed endoscopic endonasal resection of 57 skull base tumors with 3T intraoperative magnetic resonance imaging (iMRI). Among these resections, cases with previous endonasal surgery and cases for which the iMRI did not cover the entire nasal cavity were excluded. Finally, six cases with and 19 cases without SIT were included in the subsequent retrospective analysis. We measured the dimensions of the narrowest area in inferior nasal cavity on pre- and intraoperative coronal plane gadolinium (Gd)-enhanced T1-weighted MR images using dedicated software, and compared them. The incidence rates of postoperative nasal complaints at outpatient clinics were also compared. Considerable widening of the inferior nasal cavity could be achieved with the SIT, which was statistically significant compared with those without the SIT (111.1 ± 56.5% vs. 39.4 ± 59.4%, respectively; P = 0.0093). In terms of the incidence rate of postoperative nasal complaints at 6 months, there was no statistical difference between the groups (33.3% vs. 15.8%, respectively; P = 0.35). SIT is effective for widening the surgical corridor while keeping nasal function and is especially helpful for lower clivus and laterally extended skull base lesions.
鼻腔是内镜经鼻颅底手术的唯一手术通道；然而，有时它太窄，无法进行广泛的手术操作。在这里，我们展示了黏膜下下鼻甲切除术（SIT）的技术，以扩大这个手术通道。通过比较术前和术中的磁共振图像来定量评估其有效性。2015 年 3 月至 2018 年 10 月，我们使用 3T 术中磁共振成像（iMRI）对 57 例颅底肿瘤进行了内镜经鼻颅底切除术。在这些切除术中，排除了先前有经鼻手术的病例和 iMRI 未覆盖整个鼻腔的病例。最后，有 6 例进行了 SIT，19 例未进行 SIT，随后对这 25 例病例进行了回顾性分析。我们使用专用软件测量了术前和术中冠状面钆增强 T1 加权磁共振图像上鼻腔最窄部位的尺寸，并进行了比较。还比较了门诊术后鼻腔不适的发生率。SIT 可显著扩大下鼻甲的空间，与未行 SIT 的病例相比，差异具有统计学意义（分别为 111.1±56.5%和 39.4±59.4%；P=0.0093）。在术后 6 个月鼻腔不适的发生率方面，两组之间没有统计学差异（分别为 33.3%和 15.8%；P=0.35）。SIT 在保持鼻腔功能的同时，有效地扩大了手术通道，特别有助于治疗下斜坡和外侧扩展颅底病变。
