Li Haiyan, Zhai Xiang, He Jingchuan, Zhang Jinling, Liu Gang
Department of Otolaryngology Head and Neck Surgery,Tianjin Huanhu Hospital,Tianjin,300350,China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 May;36(5):352-356. doi: 10.13201/j.issn.2096-7993.2022.05.006.
To investigate the surgical approach of transnasal endoscopic resection of benign lesions in the paramedian lateral skull base. Retrospectively analyze 40 cases of the clinical data of patients with benign lesions of the skull base from August 2018 to February 2021 with transnasal endoscopic surgery, including 9 cases of cholesteatoma, 6 cases of hemangioma, 1 case of hemangiopericytoma, 6 cases of schwannoma, 15 cases of sphenoid sinus lateral crypt meningocele and cerebrospinal fluid leak, 3 cases of nasopharyngeal carcinoma bone inflammation after radiotherapy. All patients underwent transnasal endoscopic surgery, and different surgical approaches were selected according to the lesion location. The total resection rate was 100% in 40 patients. One patient had cerebrospinal fluid rhinorrhea, which was cured after repair. During the follow-up period of 3-30 months, 39 patients had different degrees of numbness in the maxillary or mandibular region, and the numbness disappeared from 2 weeks to 6 months; one patient with schwannoma still had numbness on one side of the upper lip one year after surgery. Transnasal endoscopic resection of benign lesions in the paramedian skull base has a high surgical safety and cure rate. The surgical approach selection mainly focuses on the pterygoid process and extends to the periphery. The shortest and least damaging approach should be selected according to the lesion location, and the endoscopic approach should also be selected according to the surgeon's expertise.
探讨经鼻内镜切除中鼻道外侧颅底良性病变的手术入路。回顾性分析2018年8月至2021年2月采用经鼻内镜手术治疗的40例颅底良性病变患者的临床资料,其中胆脂瘤9例,血管瘤6例,血管外皮细胞瘤1例,神经鞘瘤6例,蝶窦外侧隐窝脑膜膨出及脑脊液漏15例,鼻咽癌放疗后骨炎症3例。所有患者均接受经鼻内镜手术,根据病变部位选择不同的手术入路。40例患者全切率为100%。1例患者出现脑脊液鼻漏,修补后治愈。随访3~30个月,39例患者上颌或下颌区域有不同程度麻木,麻木在2周~6个月消失;1例神经鞘瘤患者术后1年上唇一侧仍有麻木。经鼻内镜切除中鼻道颅底良性病变手术安全性及治愈率高。手术入路选择主要围绕翼突并向外周扩展,应根据病变部位选择最短、损伤最小的入路,同时也应根据术者的技术专长选择内镜入路。