Wang Wei-Hsin, Lan Ming-Ying, Snyderman Carl H, Gardner Paul A
Department of Neurosurgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
Oper Neurosurg. 2021 May 13;20(6):E434-E435. doi: 10.1093/ons/opab004.
This 59-yr-old man presented with headache, dizziness, diplopia, and right-side hearing impairment for years. The objective degree of hearing impairment was not available. Magnetic resonance imaging (MRI) showed a right petrous apex lesion centered behind the right petrous internal carotid artery and extending lateral to the medial aspect of the right internal auditory canal. A combined endoscopic endonasal and left contralateral transmaxillary (CTM) approach was performed, and gross-total resection was achieved. Peeling the cyst wall from the dura resulted in minor weeping. It was covered with a left-sided, vascularized nasoseptal flap. His dizziness and diplopia improved immediately after the surgery. Histopathology revealed an epidermoid cyst. In this surgical video, we demonstrate the key steps of the CTM approach for access to the petrous apex posterior to the petrous internal carotid artery (ICA). The patient gave informed consent for surgery and video recording.
这位59岁男性多年来一直有头痛、头晕、复视及右侧听力障碍症状。听力障碍的客观程度不详。磁共振成像（MRI）显示右侧岩尖病变，位于右侧岩部颈内动脉后方，向内侧延伸至右侧内耳道内侧缘外侧。采用内镜经鼻联合左侧对侧经上颌窦（CTM）入路，实现了肿瘤全切。从硬脑膜上剥离囊肿壁时有少量渗血。用带血管蒂的左侧鼻中隔瓣覆盖。术后其头晕和复视立即改善。组织病理学检查显示为表皮样囊肿。在此手术视频中，我们展示了CTM入路到达岩部颈内动脉（ICA）后方岩尖的关键步骤。患者已签署手术及视频录制知情同意书。
