Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, 2 Rue Ambroise Paré, 75010, Paris, France.
Service de Neuroradiologie, AP-HP, Hôpital Lariboisière, Paris, France.
Eur Arch Otorhinolaryngol. 2023 Dec;280(12):5369-5378. doi: 10.1007/s00405-023-08106-6. Epub 2023 Jul 6.
Inverted papilloma of the sphenoid sinus (IPSS) is a rare tumor with debated surgical management due to its proximity to vital structures. The aim of this manuscript is to highlight the role of a transpterygoid approach (TPA) and pedicle-orientated strategy in case of involvement of critical structures in IPSS and compare it with data from the literature.
Patients with primary IPSS between January 2000 and June 2021 were included. Pre-operative CT/MRI were analyzed to classify the pneumatization of the SS and predict the insertion point of the inverted papilloma. All patients were treated with a trans-sphenoidal approach which was combined with a TPA in case of lateral insertion point. A systematic search was also performed to summarize the available literature.
Twenty-two patients were treated for IPSS. By CT, the SS was categorized with type III pneumatization in 72.8% of cases. Eleven patients (50%) were treated with a TPA with a statistical association with the insertion point on the SS lateral wall (p = 0.01), rather than a SS pneumatization (p = 0.63). The overall success was 95.5% after a mean follow-up of 35.9 months. For the literature, 26 publications were included on 97 patients and described a trans-sphenoidal approach with a success rate of 84.6% after a mean follow-up of 24.5 months.
IPSS is generally treated with a sphenoidotomy approach, although in selected cases, a TPA should be preferred to expose the whole SS lateral wall though allowing a complete pedicled oriented resection of the tumor.
蝶窦内翻性乳头状瘤（IPSS）是一种罕见的肿瘤，由于其与重要结构毗邻，因此其手术治疗存在争议。本文旨在强调在涉及关键结构的情况下，经蝶窦入路（TPA）和蒂向性策略的作用，并将其与文献数据进行比较。
纳入 2000 年 1 月至 2021 年 6 月期间的原发性 IPSS 患者。对术前 CT/MRI 进行分析，以对 SS 气腔进行分类，并预测内翻性乳头状瘤的插入点。所有患者均采用经蝶窦入路治疗，如果存在外侧插入点，则联合 TPA。还进行了系统搜索以总结现有文献。
22 例患者因 IPSS 接受治疗。通过 CT，72.8%的病例 SS 分类为 III 型气腔。11 例（50%）患者采用 TPA 治疗，与 SS 外侧壁的插入点有统计学关联（p=0.01），而不是 SS 气腔化（p=0.63）。平均随访 35.9 个月后，总体成功率为 95.5%。对于文献，共纳入 26 篇出版物，涉及 97 例患者，描述了经蝶窦入路，平均随访 24.5 个月后成功率为 84.6%。
IPSS 通常采用蝶窦切开术治疗，但在选择病例时，应优先选择 TPA，以暴露整个 SS 外侧壁，同时允许对肿瘤进行完全蒂向性切除。
