Liu Q, Wang H, Sun X C, Yu H P, Gu Y R, Li H Y, Zhao W D, Yu H M, Wang D H
Department of Otorhinolaryngology Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Jan 7;56(1):11-17. doi: 10.3760/cma.j.cn115330-20200828-00708.
To evaluate the feasibility of the endoscopic transnasal approach (ETA) and to analyze the outcomes and factors of this surgical technique in the management of the tumor invading the anterior skull base. A retrospective analysis was performed on 42 patients (31 males and 11 females, with mean age of 49 years) with sinonasal tumor invading the anterior skull base, who underwent ETA from June 2015 to April 2019 in Eye, Ear, Nose and Throat Hospital of Fudan University. Pathologically, there were 15 cases of squamous carcinoma (14 patients with T4bN0M0 and 1 patient with T4bN1M0) and 27 of olfactory neuroblastomas with Kadish stage C. Anterior skull base reconstruction was performed using the vascular pedicled nasoseptal mucoperiosteal flap and fascia lata. Brain non-contrast-enhanced CT was performed on the first postoperative day to exclude massive pneumocephalus, relevant brain edema and subarachnoid hemorrhage. Sinonasal contrast-enhanced MR was performed to assess the extent of the tumor removal. Kaplan-Meier analysis was used to calculate the overall survival (OS) and Cox multivariate regression analysis was used to determine the prognostic factors. The mean duration of the surgery was 452 minutes. Total resection was performed in 36 patients (85.7%), subtotal resection in 2 patients (4.8%) with orbital involvement, partial resection in one patient (2.4%) with injury of the internal carotid artery. One patient (2.4%) underwent the second resection because of the tumor residual, two patients (4.8%) with unsure tumor residual. Mean follow-up was 20 months, with 17 months of median follow-up. One-, two-and three-year overall survival was 86.5%, 76.9% and 64.5%, respectively. For squamous carcinoma, one-, two-and three-year overall survival was 86.2%, 86.2% and 57.4%, respectively. For olfactory neuroblastomas, One-, two-and three-year overall survival was 86.9%, 75.3% and 67.8%, respectively. Multivariate analysis showed that tumor residual (=0.001) and recurrence (<0.01) were independent prognostic factors for survival. The ETA is safe and feasible in selected patients with sinonasal tumor invading the anterior skull base. Tumor residual and recurrence are independent prognostic factors for survival.
评估经鼻内镜入路（ETA）治疗侵犯前颅底肿瘤的可行性，并分析该手术技术的疗效及相关因素。对2015年6月至2019年4月在复旦大学附属眼耳鼻喉科医院接受ETA治疗的42例侵犯前颅底的鼻窦肿瘤患者（男31例，女11例，平均年龄49岁）进行回顾性分析。病理检查显示，有15例鳞状细胞癌（14例T4bN0M0，1例T4bN1M0）和27例Kadish C期嗅神经母细胞瘤。采用带血管蒂鼻中隔黏骨膜瓣和阔筋膜进行前颅底重建。术后第1天进行脑部非增强CT检查，以排除大量气颅、相关脑水肿和蛛网膜下腔出血。进行鼻窦增强磁共振成像以评估肿瘤切除范围。采用Kaplan-Meier分析计算总生存率（OS），并采用Cox多因素回归分析确定预后因素。手术平均时长为452分钟。36例（85.7%）患者实现全切，2例（4.8%）因累及眼眶行次全切，1例（2.4%）因颈内动脉损伤行部分切除。1例（2.4%）因肿瘤残留接受二次手术，2例（4.8%）肿瘤残留情况不明。平均随访20个月，中位随访时间为17个月。1年、2年和3年总生存率分别为86.5%、76.9%和64.5%。鳞状细胞癌1年、2年和3年总生存率分别为86.2%、86.2%和57.4%。嗅神经母细胞瘤1年、2年和3年总生存率分别为86.9%、75.3%和67.8%。多因素分析显示，肿瘤残留（=0.001）和复发（<0.01）是生存的独立预后因素。ETA对于部分侵犯前颅底的鼻窦肿瘤患者安全可行。肿瘤残留和复发是生存的独立预后因素。
