Department of Otorhinolaryngology Head and Neck Surgery, Ankara University Faculty of Medicine, Ankara, Turkey.
Deparrment of Otorhinolaryngology Head and Neck Surgery, Salzburg Paracelcus University, Salzburg, Austria.
J Craniofac Surg. 2022;33(8):2473-2476. doi: 10.1097/SCS.0000000000008687. Epub 2022 Jun 29.
The aim of this study is to assess the effectiveness and safety of purely endonasal endoscopic resection of extracranial trigeminal schwannomas (TGSs), with assessment of surgical and clinical outcomes in order to identify optimal candidates for an endonasal endoscopic approach (EEA).
A retrospective review of patient's records operated for TGSs between 2008 and 2021 was conducted. Patients operated with a purely EEA were included in this study. Pictures from a frozen fresh cadaver head dissection were used to demonstrate the surgical approach and to show anatomic relationships, complexity of the surgical area and safe corridors for surgery.
A total of 5 patients (4 females and 1 male) were operated for TGS. All patients had facial numbness (100%) as a presenting symptom, followed by facial pain in 2 patients (40%), and orbital pain in 1 (20%). Also, 3 patients (60%) had a tumor originating at the level of the foramen ovale and 2 (40%) at the foramen rotundum. The mean tumor diameter was 3,7 ± 2 cm. Gross total resection were achieved in all cases. Postoperatively, 1 patient had severe mastication problems, 1 had blurred vision, and in the long-term follow-up, 1 had frontal sinusitis. The mean follow up was 106.6 (min:49, max:132, SD: 29.82) months. No recurrences were detected.
In cases with the extradural TGS having limited extension into Posterior Cranial Fossa, or located in the Middle Cranial Fossa, a purely EEA is possible even for tumors bigger in size. Unilateral endonasal corridors are adequate for resection in most cases.
本研究旨在评估单纯经鼻内镜颅外三叉神经鞘瘤（TGS）切除术的有效性和安全性，并评估手术和临床结果，以确定经鼻内镜入路（EEA）的最佳适应证。
对 2008 年至 2021 年间接受 TGS 手术的患者病历进行回顾性分析。本研究纳入了仅行 EEA 手术的患者。我们使用冰冻新鲜尸体头颅解剖的图片来演示手术入路，并展示解剖关系、手术区域的复杂性以及手术的安全通道。
共有 5 名患者（4 名女性和 1 名男性）因 TGS 接受手术。所有患者均以面部麻木（100%）为首发症状，其次是 2 名患者（40%）面部疼痛，1 名患者（20%）眼眶疼痛。此外，3 名患者（60%）的肿瘤起源于卵圆孔水平，2 名患者（40%）起源于圆孔。肿瘤平均直径为 3.7±2cm。所有病例均实现大体全切除。术后，1 例患者出现严重咀嚼问题，1 例患者出现视力模糊，长期随访时 1 例患者出现额窦炎。平均随访时间为 106.6 个月（最短：49 个月，最长：132 个月，标准差：29.82）。未发现复发。
对于局限于颅后窝外或位于中颅窝的 TGS，即使肿瘤较大，单纯 EEA 也是可行的。在大多数情况下，单侧经鼻通道足以切除肿瘤。
