Wei X M, Gao Z Q, Xu Z Q, Yang H, Zhang Z H, Tian X, Zhao Y, Zhou Y L, Feng G D
Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Sep 7;55(9):814-821. doi: 10.3760/cma.j.cn115330-20191015-00627.
To investigate the technical points and clinical application of combined infratemporal fossa approaches (CIFA) by analyzing the clinical results with CIFA for lesions involved skull base. A retrospective study was performed on 11 patients underwent CIFA for skull base lesions dissection from December 2014 to January 2019 in the department of otolaryngology, Peking Union Medical College Hospital. There were 6 male and 5 female patients, with age range of 16-72 years old and median age of 53 years old. Five patients underwent CIFA Type B and D, and the other 6 underwent CIFA A and B. All patients were followed up regularly by CT and MRI to observe possible recurrence. Among the 5 patients with CIFA Type B and D, 3 were giant cell tumor and 2 were giant cell reparative granuloma, and median maximum cross-section size was 42 mm×46 mm (range from 37 mm×18 mm to 56 mm×53 mm). Among the 6 patients with CIFA Type A and B, 4 were paraganglioma of head and neck, 1 was schwannoma of skull base, 1 was petrous cholesteatoma, and median maximum cross-section size was 43 mm×36 mm (range from 24 mm×22 mm to 63 mm×35 mm). Nine patients underwent complete resection of the tumor in the first stage. In 2 patients, the extracranial parts were removed in the first stage, and the intracranial part was removed in the second stage. Tympanum and ossicular reconstruction were done in one of the CIFA Type B and group D, and 1 year's postoperative hearing was mild conductive hearing loss. There was no cerebrospinal fluid leakage of all patients. All the 5 patients with normal facial nerve function before surgery recovered to H-B grade Ⅰ to Ⅱ within 3 months after surgery. Among the 4 patients whose preoperative facial nerve function were grade Ⅱ, 2 recovered to grade I after surgery and the other 2 were still grade Ⅱ. For the patient whose preoperative facial nerve function was grade Ⅴ, his postoperative recovery was grade Ⅲ. There was 1 patient whose pre-operative FN function was H-B grade Ⅲ, and the post-operative FN function was grade Ⅵ due to FN resection. Except for 2 cases with cochlear involved before surgery, cochleae of the other 9 cases were preserved. The follow-up time was 14 to 58 months. No recurrence was observed in all patients. The CIFA can safely and completely remove the extensive lesions that invade the skull base, and the facial nerve function can be well protected and recovered intro-and post-operation. Appropriate use of combined IFA can not only achieve good exposure and complete resection of lesions, but also create conditions for functional reconstruction.
通过分析联合颞下窝入路（CIFA）治疗累及颅底病变的临床结果，探讨其技术要点及临床应用。对2014年12月至2019年1月在北京协和医院耳鼻咽喉科接受CIFA治疗颅底病变切除术的11例患者进行回顾性研究。其中男性6例，女性5例，年龄16 - 72岁，中位年龄53岁。5例患者采用CIFA B型和D型，另外6例采用CIFA A型和B型。所有患者均定期行CT和MRI检查以观察有无复发。在采用CIFA B型和D型的5例患者中，3例为巨细胞瘤，2例为巨细胞修复性肉芽肿，最大横截面尺寸中位数为42 mm×46 mm（范围为37 mm×18 mm至56 mm×53 mm）。在采用CIFA A型和B型的6例患者中，4例为头颈部副神经节瘤，1例为颅底神经鞘瘤，1例为岩部胆脂瘤，最大横截面尺寸中位数为43 mm×36 mm（范围为24 mm×22 mm至63 mm×35 mm）。9例患者在第一阶段实现肿瘤全切。2例患者在第一阶段切除颅外部份，第二阶段切除颅内部分。在CIFA B型和D型组中的1例患者进行了鼓膜和听骨链重建，术后1年听力为轻度传导性听力损失。所有患者均无脑脊液漏。术前面神经功能正常的5例患者术后3个月内均恢复至H - B Ⅰ至Ⅱ级。术前面神经功能为Ⅱ级的4例患者中，2例术后恢复至Ⅰ级，另2例仍为Ⅱ级。术前面神经功能为Ⅴ级的患者，术后恢复为Ⅲ级。有1例术前FN功能为H - B Ⅲ级的患者，术后因FN切除功能为Ⅵ级。除术前2例累及耳蜗外，其余9例耳蜗均得以保留。随访时间为14至58个月。所有患者均未观察到复发。CIFA能够安全、彻底地切除侵犯颅底的广泛病变，术中及术后面神经功能能够得到良好保护和恢复。合理应用联合IFA不仅能实现病变的良好暴露和全切，还能为功能重建创造条件。
