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纯内镜经蝶窦治疗伴颅内侵犯的颅底成釉细胞瘤:病例报告及文献复习

Pure endoscopic transsphenoidal treatment of skull base ameloblastoma with intracranial extension: Case report and literature review.

作者信息

Ferreira Tiago Silva Holanda, Pimentel Isnara Mara Freitas, de Albuquerque Lucas Alverne Freitas, Gondim Jackson A

机构信息

Departments of Neurosurgery, General Hospital of Fortaleza, Avila Goulart, Fortaleza, Ceara, Brazil.

Departments of Otorhinolaringology, General Hospital of Fortaleza, Avila Goulart, Fortaleza, Ceara, Brazil.

出版信息

Surg Neurol Int. 2020 Aug 1;11:228. doi: 10.25259/SNI_45_2020. eCollection 2020.

Abstract

BACKGROUND

Ameloblastoma is a benign locally invasive lesion that represents 1% of all oral tumors. Epidemiological characteristics are variable in the literature. The most common origin sites are mandible and maxilla. Rarely presents metastasis, but the skull base, lymph nodes, and the lung are described as metastatic sites. Low recurrence rates were reported by the authors when surgical treatment achieved complete resection.

CASE DESCRIPTION

A female patient, 19 years old presenting moderate headache associated with nausea, vomiting, left facial hypoesthesia, and low visual acuity. Resonance image showed a heterogeneous expansive solid formation in sphenoid bone and clivus with neoplastic aspect. Signs of dissemination due to contiguity and invasion of skull base structures, especially cavernous sinus and internal carotid artery, determining also compression of the brainstem. First, an endoscopic biopsy was performed with otorhinolaryngology service. The pathological study showed histological characteristics of ameloblastoma. After, the patient was submitted to endoscopic surgery for resection of tumor.

CONCLUSION

Ameloblastoma is a rare tumor with benign behavior and slow growing. It arises from odontogenic epithelium and accounts 1% of all oral tumors. The mandible and maxilla are the most common sites of origin. Ameloblastoma with intracranial involvement is a rare presentation with few literature reviews. A long time illness course and multiple surgeries are characteristics present in the majority of cases described. Total resection surgery is the treatment of choice and endoscopic transnasal resection is a viable option.

摘要

背景

成釉细胞瘤是一种良性的局部侵袭性病变,占所有口腔肿瘤的1%。文献中其流行病学特征存在差异。最常见的起源部位是下颌骨和上颌骨。很少发生转移,但颅底、淋巴结和肺被描述为转移部位。作者报告称,当手术治疗实现完全切除时,复发率较低。

病例描述

一名19岁女性患者,出现中度头痛,伴有恶心、呕吐、左侧面部感觉减退和视力低下。磁共振成像显示蝶骨和斜坡有一个不均匀的膨胀性实性肿物,具有肿瘤特征。由于肿物邻近并侵犯颅底结构,特别是海绵窦和颈内动脉,出现扩散迹象,还导致脑干受压。首先,耳鼻喉科进行了内镜活检。病理研究显示有成釉细胞瘤的组织学特征。之后,患者接受了内镜手术切除肿瘤。

结论

成釉细胞瘤是一种罕见的肿瘤,行为良性,生长缓慢。它起源于牙源性上皮,占所有口腔肿瘤的1%。下颌骨和上颌骨是最常见的起源部位。颅内受累的成釉细胞瘤是一种罕见表现,文献综述较少。大多数所述病例的特点是病程长和多次手术。全切除手术是首选治疗方法,内镜经鼻切除是一种可行的选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe53/7451162/b130160d62e2/SNI-11-228-g001.jpg

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