Kobayashi Kenya, Miyakita Yasuji, Matsumoto Fumihiko, Omura Go, Matsumura Satoko, Ikeda Atsuo, Eguchi Kohtaro, Ito Akiko, Narita Yoshitaka, Akazawa Satoshi, Yoshimoto Seiichi
Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan.
Department of Neurosurgery and Neuro-oncology, National Cancer Center Hospital, Tokyo, Japan.
J Neurol Surg B Skull Base. 2021 May 23;83(Suppl 3):e639-e640. doi: 10.1055/s-0041-1727123. eCollection 2022 Aug.
In traditional craniofacial resection of tumors invading the anterior skull base, the bilateral olfactory apparatus is resected. Recently, transnasal endoscopy has been used for olfactory preservation in resections of unilateral low-grade malignancies. However, for tumors that invade the orbita or for high-grade malignancies, the transnasal endoscopic skull base surgery has been controversial. This video demonstrates the surgical techniques of olfactory preservation during craniofacial resection of a high-grade malignancy invading the hemianterior skull base and orbita. We present the case of a 32-year-old woman with osteosarcoma in the right ethmoid sinus. The tumor invaded the ipsilateral cribriform plate, dura menta, and orbital periosteum; however, the nasal septum and crista galli were intact ( Fig. 1A, B ). Because the tumor was a high-grade malignancy and the orbita had been invaded, we performed craniofacial resection instead of endoscopic resection ( Fig. C2A ). We drilled into the right side of the crista galli, midline of the cribriform plate, and perpendicular plate of the ethmoid bone via craniotomy. As a result, we accessed the nasal cavity directly ( Fig. 2B ). To preserve the nasal septum, we detached the remaining right septal mucosa through the transfacial approach ( Fig. 2C ). Because of the high risk of cerebrospinal fluid leakage as a result of previous irradiation, we performed vascularized free flap reconstruction of the skull base instead of pericranial flap. Postoperative computed tomography revealed no evidence of tumor ( Fig. 1C, D ). The patient's sense of smell returned after 1 postoperative day, and she was discharged on the postoperative day 14. The link to the video can be found at: https://youtu.be/XzPABYwzkjs .
在传统的颅面手术切除侵犯前颅底的肿瘤时，双侧嗅觉器官会被切除。近来，经鼻内镜已用于单侧低级别恶性肿瘤切除术中的嗅觉保留。然而，对于侵犯眼眶的肿瘤或高级别恶性肿瘤，经鼻内镜颅底手术一直存在争议。本视频展示了在颅面手术切除侵犯半侧前颅底和眼眶的高级别恶性肿瘤过程中保留嗅觉的手术技巧。我们报告一例32岁右侧筛窦骨肉瘤女性患者。肿瘤侵犯同侧筛板、硬脑膜和眶骨膜；然而，鼻中隔和鸡冠完整（图1A、B）。由于肿瘤为高级别恶性肿瘤且眼眶已被侵犯，我们实施了颅面切除术而非内镜切除术（图C2A）。我们通过开颅术在鸡冠右侧、筛板中线和筛骨垂直板钻孔。结果，我们直接进入鼻腔（图2B）。为保留鼻中隔，我们通过经面部入路分离剩余右侧鼻中隔黏膜（图2C）。由于既往放疗导致脑脊液漏的风险高，我们采用带血管蒂游离皮瓣重建颅底而非颅骨膜瓣。术后计算机断层扫描未发现肿瘤迹象（图1C、D）。患者术后第1天嗅觉恢复，术后第14天出院。视频链接可在：https://youtu.be/XzPABYwzkjs 找到。
