内镜下经鼻-翼突入路切除翼突周围颅底病变的临床分析

Endoscopic endonasal transpterygoid approach for resection of skull base lesions around pterygoid process

摘要:

目的探讨内镜下经鼻-翼突入路处理翼突周围颅底病变的手术方式。方法回顾性分析2015—2019年蚌埠医学院第一附属收治的10例内镜下经鼻-翼突入路治疗颅底病变的临床资料，其中神经鞘瘤2例，鼻咽纤维血管瘤2例，恶性黑色素瘤2例，嗅神经母细胞瘤1例，内翻性乳头状瘤1例，腺样囊性癌1例，胆脂瘤1例。结果8例患者完整切除肿瘤；1例嗅神经母细胞瘤患者术中鼻腔内肿瘤切除，颅内肿瘤残留，术后辅助化疗，肿瘤控制；1例神经鞘瘤术中瘤体出血，肿瘤残余。术后1例胆脂瘤患者出现术侧眼干、面部感觉减退，4个月后症状缓解；所有患者术后随访4~41个月，无复发。结论内镜下经鼻-翼突入路是处理翼突周围颅底病变的有效手段，可有效减少术中出血及术后并发症，安全性高。

Abstract:

ObjectiveTo explore the surgical option of endoscopic endonasal transpterygoid approach for the treatment of skull base lesions around pterygoid process.MethodsClinical data of 10 patients with skull base lesions surgically treated via endoscopic endonasal transpterygoid approach in our department from 2015 to 2019 were retrospectively analyzed. The lesions included schwannomas (n=2), nasopharyngeal fibroangioma (n=2), malignant melanoma (n=2), olfactory neuroblastoma (n=1), inverted papilloma (n=1), adenoid cystic carcinoma (n=1), and cholesteatoma (n=1).ResultsComplete tumor resection was achieved in 8 patients. Resection of intranasal portion of olfactory neuroblastoma was performed in one patient with intracranial residue controlled by postoperative chemotherapy. Schwannomas residue occurred due to intraoperative hemorrhage in one case. The patient with cholesteatoma had postoperative dry eye and facial hypoesthesia relieved in 4 months. Followup for 4 to 41 months revealed recurrence in none.ConclusionWith incomparable advantages of high safety, effective reduction of intraoperative hemorrhage and postoperative complications, endoscopic endonasal transpterygoid approach is effective for the treatment of skull base lesions around pterygoid process.