Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia; Department of Otolaryngology, Head and Neck Surgery, St Vincent's Hospital, Sydney, Australia.
Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia; Department of Neurosurgery, Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Brain and Mind Centre, University of Sydney, Camperdown, Sydney, New South Wales, Australia.
World Neurosurg. 2023 Jul;175:e391-e396. doi: 10.1016/j.wneu.2023.03.103. Epub 2023 Mar 31.
Radiologically undifferentiated lesions of the cavernous sinus can pose a diagnostic challenge. Although radiotherapy is the mainstay for treatment of cavernous sinus lesions, histologic diagnosis allows access to a wide variety of alternative treatment modalities. The region is considered a high-risk area for open transcranial surgical access, and the endoscopic endonasal approach presents an alternative technique for biopsy.
A retrospective case series was performed of all patients undergoing endoscopic endonasal biopsy of isolated cavernous sinus lesions at 2 tertiary institutions. The primary outcomes were the percentage of patients in whom a histologic diagnosis was achieved and the proportion of patients in whom therapy differed from radiotherapy alone. Secondary outcomes included preoperative and postoperative 22-item Sino-Nasal Outcome Test symptom scores, as well as perioperative adverse outcomes.
Eleven patients underwent endoscopic endonasal biopsy, with a diagnosis achieved in 10 patients. The most common diagnosis was perineural spread of squamous cell carcinoma, followed by perineuroma and single cases of metastatic melanoma, metastatic adenoid cystic carcinoma, mycobacterium lepri infection, neurofibroma, and lymphoma. Six patients had treatments other than radiotherapy, including immunotherapy, antibiotics, corticosteroids, chemotherapy, and observation alone. There was no significant difference in prebiopsy and postbiopsy 22-item Sino-Nasal Outcome Test scores. There was 1 case of epistaxis requiring return to theater for cautery of the sphenopalatine artery and there were no mortalities.
In a limited case series, endoscopic endonasal biopsy was safe and effective in obtaining diagnosis for cavernous sinus lesions and had a significant impact on therapeutic decision making.
海绵窦内未分化的病变可能会带来诊断上的挑战。虽然放射治疗是治疗海绵窦病变的主要方法，但组织学诊断可以获得多种替代治疗方法。该区域被认为是开颅手术入路的高风险区域，而经鼻内镜入路则提供了一种替代活检的技术。
对 2 家三级医疗机构的所有孤立性海绵窦病变行经鼻内镜活检的患者进行回顾性病例系列研究。主要结局指标为获得组织学诊断的患者比例，以及与单纯放射治疗不同的治疗方案的患者比例。次要结局指标包括术前和术后 22 项鼻窦结局测试症状评分，以及围手术期不良结局。
11 例患者接受了经鼻内镜活检，其中 10 例获得了诊断。最常见的诊断是鳞状细胞癌的神经周围播散，其次是神经鞘瘤和单发的转移性黑色素瘤、转移性腺样囊性癌、利什曼原虫感染、神经纤维瘤和淋巴瘤。6 例患者接受了放疗以外的治疗，包括免疫治疗、抗生素、皮质类固醇、化疗和单纯观察。22 项鼻窦结局测试评分在活检前和活检后均无显著差异。有 1 例鼻出血，需返回手术室用电烙术烧灼蝶腭动脉，无死亡病例。
在一项有限的病例系列研究中，经鼻内镜活检在获得海绵窦病变的诊断方面是安全有效的，并且对治疗决策有显著影响。
