Shelesko E V, Chernikova N A, Kravchuk A D, Strunina Yu V, Okhlopkov V A, Zinkevich D N, Batalov A I, Solozhentseva K D
Burdenko National Medical Research Center for Neurosurgery, Moscow, Russia.
Vestn Otorinolaringol. 2021;86(6):74-81. doi: 10.17116/otorino20218606174.
Determine the influence of the anatomical features and sizes of the lateral pocket with a defect on the choice of surgical access and the quality of the performed plastics.
A retrospective analysis of computed tomograms of 38 patients who underwent surgical treatment at the Burdenko National Medical Research Center for Neurosurgery of the Ministry of Health of Russia about defects of the skull base in the area of the lateral pocket of the sphenoid sinus. The patients were divided into three groups depending on the approach used (the 1st group), the recurrence rate (the 2nd group), and the characteristics of intraoperative visualization of the defect (the 3rd group).
There were no statistically significant differences in anatomical features in patients who underwent trans-pterygoid and transsphenoidal approaches, as well as in patients of the 2nd group. Patients of the 3rd group (with visualization features) showed statistically significant differences between the distance from the defect to the VR line (=0.007). In patients with good visualization of the defect using direct optics, this distance was shorter than in patients in whom the defect was visualized with an angled endoscope. No other anatomical differences were noted.
The anatomical features of the lateral pocket structure (type of pneumatization, size and volume) did not affect the choice of access to the defect and the frequency of recurrence. When comparing the approaches, it was noted that the trans-pterygoid access, providing direct visualization of defects, minimizes the risk of recurrence in the postoperative period. An objective anatomical indicator for choosing an access to the defects of the lateral pocket can be the distance from the defect to the VR line: at a distance of more than 0.7 cm, it is advisable to perform a trans-pterygoid approach; at a distance of less than 0.7 cm, it is possible to achieve direct visualization of the defect and perform high-quality plastic surgery with a transsphenoidal access.
确定存在缺损的外侧隐窝的解剖特征和大小对手术入路选择及所施行整形手术质量的影响。
对在俄罗斯卫生部国家医学研究神经外科布尔坚科中心接受蝶窦外侧隐窝区域颅底缺损手术治疗的38例患者的计算机断层扫描图像进行回顾性分析。根据所采用的入路（第1组）、复发率（第2组）和缺损的术中可视化特征（第3组）将患者分为三组。
接受经翼突入路和经蝶入路的患者以及第2组患者在解剖特征方面无统计学显著差异。第3组（具有可视化特征）患者在缺损至VR线的距离方面存在统计学显著差异（=0.007）。使用直视光学系统能良好可视化缺损的患者，该距离短于使用角度内镜可视化缺损的患者。未发现其他解剖差异。
外侧隐窝结构的解剖特征（气化类型、大小和容积）不影响对缺损的入路选择和复发频率。比较不同入路时发现，经翼突入路可直接可视化缺损，能将术后复发风险降至最低。选择外侧隐窝缺损入路的客观解剖学指标可为缺损至VR线的距离：距离大于0.7 cm时，建议采用经翼突入路；距离小于0.7 cm时，经蝶入路有可能实现对缺损的直接可视化并施行高质量的整形手术。
