Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan.
Sci Prog. 2024 Jul-Sep;107(3):368504241263524. doi: 10.1177/00368504241263524.
The resection of middle ear paragangliomas can be challenging given their vascular nature and the small volume of the tympanic cavity, particularly when the tumor in the hypotympanum is close or attached to the internal carotid artery (ICA). We performed combined underwater endoscopic and microscopic surgery for a Class B1 middle ear paraganglioma according to the modified Fisch classification. The suspicious bone in the hypotympanum and around the petrous ICA was drilled with underwater endoscopy. The feeding arteries, the caroticotympanic and inferior tympanic arteries, were suctioned and cauterized under microscopy. To the best of our knowledge, no case of middle ear paraganglioma treated with underwater endoscopy has been reported. Underwater endoscopy, providing a clear operative field with blood and bone dust irrigation, is a good indication for middle ear paragangliomas. In contrast, microscopic preparation for unexpected bleeding is important, particularly when the tumor closely extends to vital structures, such as the ICA or the jugular bulb.
由于中耳神经鞘瘤的血管特性和鼓室腔体积小，其切除具有挑战性，特别是当位于后鼓室的肿瘤靠近或附着于颈内动脉（ICA）时。我们根据改良 Fisch 分类，对 1 例 B1 级中耳神经鞘瘤采用水下内镜显微镜联合手术。在水下内镜下对可疑的后鼓室和岩骨颈内动脉周围的骨质进行钻孔。在显微镜下，通过抽吸和电灼，将供血动脉，包括鼓室下动脉和颈鼓动脉，结扎。据我们所知，尚无采用水下内镜治疗中耳神经鞘瘤的报道。水下内镜提供了一个清晰的手术视野，可冲洗血液和骨屑，是治疗中耳神经鞘瘤的一个很好的适应证。相比之下，当肿瘤紧密延伸至重要结构，如 ICA 或颈静脉球时，显微镜下准备应对意外出血非常重要。
