Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology and Head and Neck Surgery, Ministry of Education, Beijing, P.R. China.
Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China.
Otolaryngol Head Neck Surg. 2022 Aug;167(2):382-390. doi: 10.1177/01945998211068429. Epub 2022 Jan 11.
This study aimed to assess the effectiveness of 3 endoscopic endonasal approaches for the management of cerebrospinal fluid (CSF) leaks and meningoencephaloceles in the lateral recess of the sphenoid sinus (LRSS).
Retrospective study.
University hospital.
This study retrospectively reviewed 49 patients with CSF leaks and meningoencephaloceles in the LRSS. Three endoscopic surgical repair approaches were indicated based on 5 different Rhoton's types of the LRSS. The postoperative symptoms, complications, and follow-up outcomes were investigated and evaluated.
The success rate of endoscopic surgical repair was 100% at a median follow-up of 75.06 (12-203.4) months. Endoscopic approaches to the LRSS included the prelacrimal recess (PLR) (18.37%), transsphenoidal (18.37%), and transpterygoid approaches (64.26%). All patients in the PLR approach (PLRA) group and most of the patients in the transpterygoid approach group had a full lateral type LRSS. Hypoesthesia and dry eyes were reported in 5 patients (55.56%) and 1 (11.12%) patient, respectively, from the PLRA group and in 6 (19.35%) and 5 (16.12%) patients, respectively, from the transpterygoid approach group.
Endoscopic closure is a safe and effective method for the treatment of CSF leaks and meningoencephaloceles in the LRSS. The transpterygoid approach and PLRA offer adequate exposure of the LRSS with extensive lateral pneumatization or a full LRSS. The endoscopic route of the PLRA is more direct than that of the transpterygoid approach. Careful preoperative imaging evaluation is crucial while selecting the optimal surgical approach for the repair of a skull base defect.
本研究旨在评估 3 种经鼻内镜入路治疗蝶窦外侧隐窝（LRSS）脑脊液（CSF）漏和脑膜脑膨出的效果。
回顾性研究。
大学医院。
本研究回顾性分析了 49 例 LRSS 脑脊液漏和脑膜脑膨出患者。根据 Rhoton 五种不同类型的 LRSS，选择三种内镜手术修复方法。对术后症状、并发症和随访结果进行了调查和评估。
在中位随访 75.06 个月（12-203.4 个月）时，内镜手术修复成功率为 100%。LRSS 的内镜入路包括经泪前隐窝（PLR）（18.37%）、经蝶窦（18.37%）和经翼突入路（64.26%）。PLR 入路（PLRA）组所有患者和大部分经翼突入路组患者均为完全外侧型 LRSS。PLRA 组 5 例（55.56%）和经翼突入路组 1 例（11.12%）患者出现感觉减退，PLRA 组 6 例（19.35%）和经翼突入路组 5 例（16.12%）患者出现干眼症。
内镜下闭合术是治疗 LRSS 脑脊液漏和脑膜脑膨出的一种安全有效的方法。经翼突入路和 PLRA 可充分暴露广泛气腔化或完全 LRSS 的 LRSS。PLRA 的内镜入路比经翼突入路更直接。在选择修复颅底缺损的最佳手术入路时，术前仔细的影像学评估至关重要。
