Blagoveshchenskaia N S, Egorova V K
Zh Vopr Neirokhir Im N N Burdenko. 1997 Jul-Sep(3):14-6.
Tumors extending into the nasal cavity, cranium, and paranasal sinuses have a number of distinctive features to take into consideration. Among them are the communication with an open air, high incidence of associated intracranial infections, specific complications (i.e. suppurative sinusitis, polyps, mucocele, pneumocephalus, nasal CSF leak). The features mentioned make these lesions unique. 50 consecutive patients underwent treatment in Burdenko Neurosurgical Institute. The diagnosis was confirmed either by CT, MRI, or at operation. Rhinological and otoneurological signs were also subjected to analysis. Most frequently these tumors (the majority of which were meningiomas (n = 34) extended into the nasal cavity (40 patients) and paranasal sinuses (n = 50). It was noted that the clinical signs vary depending on the histological type of tumor, its location and direction of growth (i.e. medial or lateral). Medially growing tumors usually involved 2-4 sinuses, while laterally growing tumors involved only one sinus. Among the symptoms, disturbances of smell, conductive hearing impairment, deformation of both the soft and hard palate, slowing of the experimental nystagmus due to disturbed extraocular movements. Some light is shed on the differential diagnosis, indications for various surgical approaches (transcranial, transnasal, and facial). The results of surgical treatment and postoperative complications are presented in the paper. The diagnosis and treatment of such patients require an interdisciplinary approach while would involve a team of a neurosurgeon, neuroradiologist, otoneurologist, and a neuro-ophthalmologist.
侵犯鼻腔、颅骨和鼻窦的肿瘤有许多独特特征需要考虑。其中包括与外界空气相通、颅内感染相关发生率高、特定并发症(如化脓性鼻窦炎、息肉、黏液囊肿、气颅、鼻脑脊液漏)。上述特征使这些病变独具特殊性。50例连续患者在布尔坚科神经外科研究所接受治疗。诊断通过CT、MRI或手术得以证实。鼻科和耳神经科体征也进行了分析。这些肿瘤最常见的情况(其中大多数为脑膜瘤,n = 34)侵犯鼻腔(40例患者)和鼻窦(n = 50)。值得注意的是,临床体征因肿瘤的组织学类型、位置和生长方向(即内侧或外侧)而异。向内侧生长的肿瘤通常累及2 - 4个鼻窦,而向外侧生长的肿瘤仅累及一个鼻窦。症状包括嗅觉障碍、传导性听力减退、软硬腭变形、因眼外肌运动障碍导致实验性眼球震颤减慢。文中对鉴别诊断、各种手术入路(经颅、经鼻和经面部)的适应证有所阐述。本文还介绍了手术治疗结果和术后并发症。这类患者的诊断和治疗需要多学科方法,涉及神经外科医生、神经放射科医生、耳神经科医生和神经眼科医生组成的团队。