Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Department of Neurosurgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
Acta Neurochir (Wien). 2022 Feb;164(2):331-341. doi: 10.1007/s00701-021-05068-8. Epub 2021 Nov 23.
Non-vestibular schwannomas (NVSs) of the skull base occur in several sites, and few previous studies have evaluated the usefulness of the endoscopic endonasal transmaxillary-pterygoid approach (EETMPA) to resect these lesions. We aimed to evaluate the characteristics and clinical outcomes of patients who underwent EETMPA for skull-base NVSs and to investigate the efficacy, safety, and indications for the procedure.
We retrospectively reviewed the clinical data of 10 consecutive patients (mean age, 45 ± 17) who underwent EETMPA for skull-base NVSs at the University of Tsukuba hospital between 2013 and 2020. We also calculated the total tumor volume and the size of the corridor to the tumor for EEA (SCEEA) in nine patients who underwent EEA for NVSs adjacent to the Meckel's cave or cavernous sinus.
Nine patients (9/10), including five women (5/10), underwent primary surgery. Gross total resection and subtotal resection were achieved in five patients each (5/10). Postoperatively, one patient showed a new and mild cranial nerve V sensory deficit and one patient showed slight worsening of abducens nerve palsy. The greater palatine nerve was amputated in two patients; however, permanent perception loss in the soft palate was observed in one patient. The Vidian nerve was sacrificed in four patients, and new dry eye occurred in one patient. None of the patients experienced postoperative tumor recurrence or regrowth during the follow-up period of 40 ± 28 months.
EETMPA is safe and effective for excising skull-base NVSs which are not eligible for radiosurgery leading to a high rate of successful resection and a high rate of but mild neurological sequela. The EEA is appropriate when the tumor extends to the paranasal sinus with sufficient SCEEA.
颅底非听神经鞘瘤（NVS）可发生于多个部位，既往研究较少评估经内镜颅底-鼻腔-上颌窦入路（EETMPA）切除这些病变的效果。本研究旨在评估 EETMPA 治疗颅底 NVS 的特点和临床结果，并探讨该手术的疗效、安全性和适应证。
我们回顾性分析了 2013 年至 2020 年在筑波大学医院接受 EETMPA 治疗的 10 例颅底 NVS 患者的临床资料（平均年龄 45±17 岁）。我们还计算了 9 例行 EEA 治疗毗邻 Meckel 腔或海绵窦的 NVS 患者的肿瘤总容积和到达肿瘤的通道大小（SCEEA）。
9 例患者（9/10）接受了初次手术，其中 5 例（5/10）为女性。5 例患者行肿瘤全切除，5 例患者行次全切除。术后 1 例患者出现新的轻度第 V 颅神经感觉障碍，1 例患者出现展神经麻痹稍加重。2 例患者切断了腭大神经，但 1 例患者出现软腭永久性知觉丧失。4 例患者牺牲了翼管神经，1 例患者出现新发干眼。在 40±28 个月的随访期间，无患者出现肿瘤复发或再生长。
EETMPA 治疗不适合行放射外科治疗的颅底 NVS 安全有效，可实现较高的肿瘤全切除率和较低的神经功能障碍发生率。当肿瘤延伸至鼻窦且 SCEEA 充足时，适合行 EEA。
