Montgomery W W
Ann Otol Rhinol Laryngol. 1977 Jul-Aug;86(4 Pt 1):429-35. doi: 10.1177/000348947708600402.
The transsphenoid approach to cystic lesions of the petrous tip has been made possible by the advances in techniques for diagnosis. These include polytomography, improved angiography, and computer tomographic (CT) brain scanning. The results of these studies can determine the size, shape, and thickness of the cystic lesion, as well as its exact relationship to the sphenoid sinus. A number of surgical approaches have been used to reach the cystic lesion of the petrous apex. Most notably, these include the middle fossa extradural craniotomy and posterior fossa craniotomy. These surgical techniques allow the cyst to be biopsied but do not establish permanent drainage. The translabyrinthine approach accomplishes wide access to the petrous apex, but cochlear and vestibular functions are sacrificed. The transsphenoid approach to cystic lesions of the petrous apex should be the ideal operation provided that the anterior aspect of the cyst abuts against the posterior wall of the sphenoid sinus. The cyst can be completely evacuated and permanent fistulization established into the sphenoid sinus using a septal mucosal flap and a silicone drainage device. The operation is accomplished without destruction to the inner ear.
诊断技术的进步使经蝶窦入路治疗岩尖囊性病变成为可能。这些技术包括断层摄影术、改进的血管造影术和计算机断层扫描（CT）脑部扫描。这些研究结果可以确定囊性病变的大小、形状和厚度，以及它与蝶窦的确切关系。已经采用了多种手术入路来到达岩尖的囊性病变。最值得注意的是，这些包括中颅窝硬膜外开颅术和后颅窝开颅术。这些手术技术可以对囊肿进行活检，但不能建立永久性引流。经迷路入路可广泛进入岩尖，但会牺牲耳蜗和前庭功能。如果囊肿的前侧紧靠蝶窦后壁，经蝶窦入路治疗岩尖囊性病变应该是理想的手术方式。使用鼻中隔黏膜瓣和硅胶引流装置，可以将囊肿完全排空并建立永久性瘘管进入蝶窦。该手术在不破坏内耳的情况下完成。
