蝶窦外侧隐窝脑膜脑膨出鼻内镜下经翼突径路手术

Endoscopic transpterygoid intervention of meningoencephalocele within lateral recess of sphenoid sinus

目的探讨经鼻内镜下翼突径路处理蝶窦外侧隐窝脑膜脑膨出的手术方式及其相关问题。方法总结2001-2006年住院诊断为蝶窦外侧隐窝脑膜脑膨出并脑脊液鼻漏9例患者,男6例,女3例;年龄27～56岁。其中2例患者有前期经鼻内镜手术修补史。术前 CT 扫描和磁共振脑池造影检查定位诊断脑脊液鼻漏和脑膜脑膨出。在全身麻醉下行经鼻内镜下翼突径路切除蝶窦外侧隐窝脑膜脑膨出并修补颅底手术。结果 9例患者均一次手术修补成功。1例术后并发颅内高压和脑积水,2例术后合并患侧面部、硬腭和上唇麻木,1例干眼。术后6个月症状逐渐缓解。随访6～58个月,平均25.6个月,无复发。结论蝶窦外侧隐窝脑膜脑膨出伴脑脊液鼻漏采用鼻内镜下经翼突进入蝶窦外侧隐窝术式,为一微创技术和简便手术径路。

Objective To report the results of endoscopic transpterygoid intervention of nine patients with meningoencephaolece and cerebrospinal fluid （CSF） leaks within lateral recess of sphenoid sinus （LRSS）. The diagnosis, operative techniques and their related problems were discussed. Methods Nine hospitalized patients with meningoencephaolece and CSF leaks within lateral recess of sphenoid sinus （LRSS） were included in this paper. Six were male and 3 were female, aged from 27 to 56 years old. Two patients had the histories of endoscopic repair. The preoperative orientation of CSF leaks and meningoencephalocele depended on CT scan and MR cisternography. Endoscopic transpterygoid intervention and the repair of skull base defects were undertaken under general anesthesia. Results All the operations were successful. One patient had a postoperative intracranial hypertension and Hydrocephalus. Two patients had postoperative ipsilateral facial, upper lip and palatal hypesthesia. One of them had a xerophthalmia. All the symptoms above mentioned relieved gradually 6 months after operation. No recurrence was found during follow -up for 6 to 58 months （mean 25.6 months）. Conclusions Endoscopic transpterygoid intervention for meningoencephaolece and CSF leaks within LRSS is a minimally invasive technique and a straightforward approach.