Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Head Neck. 2021 May;43(5):1535-1544. doi: 10.1002/hed.26618. Epub 2021 Jan 27.
The endoscopic endonasal trans-lacerum approach (EETLA) is useful in handling skull base tumors around inferior petrous apex (IPA); however, its surgical corridor is exclusively a triangular space (supra-eustachian triangle [SET]), between the internal carotid artery (ICA) and eustachian tube.
We investigated correlation between SET size and extent of resection around the IPA (lateral extent of resection [EOR]) through a retrospective analysis of 15 surgeries using EETLA.
Of 15 cases (9 chordomas, 4 chondrosarcomas, and 2 meningiomas), 20 sides of IPA were affected by the tumor. When being restricted to sides with severe lateral tumor extension beyond the midpoint of petrous ICA (10 sides), the SET size was significantly broader in the group with lateral EOR of ≥90% (p value = 0.019).
The SET size was a powerful index of tumor resectability in EETLA, especially in cases with severe tumor extension. The individual anatomical variations should be considered when determining EETLA application.
经鼻内镜颅底入路（EETLA）在处理颅底岩尖下部（IPA）周围的肿瘤方面非常有用；然而，其手术通道仅为一个三角形空间（咽鼓管上方三角区 [SET]），位于颈内动脉（ICA）和咽鼓管之间。
我们通过对 15 例采用 EETLA 的手术进行回顾性分析，研究了 SET 大小与 IPA 周围切除范围（侧向切除范围 [EOR]）之间的相关性。
在 15 例患者（9 例脊索瘤、4 例软骨肉瘤和 2 例脑膜瘤）中，20 侧 IPA 受到肿瘤的影响。当仅限制在严重侧向肿瘤延伸超过岩骨颈内动脉中点的侧方（10 侧）时，侧向 EOR ≥90%的组中 SET 尺寸明显更宽（p 值=0.019）。
SET 大小是 EETLA 中肿瘤可切除性的有力指标，尤其是在肿瘤严重延伸的情况下。在确定 EETLA 的应用时，应考虑个体解剖变异。
