Zhang M, Garvis W, Linder T, Fisch U
Department of Otolaryngology, Northwestern University, Evanston, Illinois, USA.
Laryngoscope. 1998 Nov;108(11 Pt 1):1717-23. doi: 10.1097/00005537-199811000-00023.
Review of preoperative evaluation, surgical management, and outcome of patients operated on for nasopharyngeal angiofibroma using lateral infratemporal fossa approaches.
Retrospective review of 20 patients with either extensive (Fisch class IIIa to IVb, n = 17) or less massive (Fisch class II, n = 3) nasopharyngeal angiofibromas. Analysis of preoperative radiologic classification and angiography and description of indications and surgical techniques of the infratemporal fossa approaches types C and D. Evaluation of the surgical morbidity and radicality of tumor removal.
Clinical data were obtained from medical records from 1987 to 1994. Tumor classification, preoperative symptoms, type of surgery, and neuroradiologic and surgical complications were evaluated. The completeness of tumor removal was assessed using postoperative magnetic resonance imaging.
Temporary visual disturbance or headache, or both, was seen in two of 20 patients after superselective tumor embolization, and further visual diminution was observed in one of six patients after balloon occlusion of the internal carotid artery. Radical resection was obtained in 80% of the cases. The infratemporal fossa type C approach was used in 16 of the cases, with type D approaches used in the other four. There were no deaths. The major morbidity was the conductive hearing loss associated with the type C approach.
Preoperative embolization (and balloon occlusion in selected cases) remains an important adjunct with minimal morbidity. The lateral infratemporal fossa approaches yield a high rate of radical tumor removal (80%) and a low rate of recurrence (6%). If applicable, the type D approach avoids the conductive hearing loss but allows direct tumor access into the infratemporal and pterygopalatine fossae.
回顾采用颞下窝外侧入路手术治疗鼻咽血管纤维瘤患者的术前评估、手术管理及预后。
对20例广泛型（Fisch IIIa至IVb级，n = 17）或较小肿块型（Fisch II级，n = 3）鼻咽血管纤维瘤患者进行回顾性研究。分析术前放射学分类及血管造影，描述C型和D型颞下窝入路的适应证及手术技术。评估手术并发症及肿瘤切除的彻底性。
从1987年至1994年的病历中获取临床资料。评估肿瘤分类、术前症状、手术类型、神经放射学及手术并发症。使用术后磁共振成像评估肿瘤切除的完整性。
20例患者中，2例在超选择性肿瘤栓塞后出现暂时性视力障碍或头痛，或两者皆有；6例患者中1例在颈内动脉球囊闭塞后出现视力进一步下降。80%的病例实现了根治性切除。16例采用C型颞下窝入路，另外4例采用D型入路。无死亡病例。主要并发症是与C型入路相关的传导性听力损失。
术前栓塞（在特定病例中采用球囊闭塞）仍是一种重要的辅助手段，并发症最少。颞下窝外侧入路肿瘤根治切除率高（80%），复发率低（6%）。如果适用，D型入路可避免传导性听力损失，但可使肿瘤直接进入颞下窝和翼腭窝。
