侵犯前中颅底的鼻咽纤维血管瘤

Nasopharyngeal angiofibroma with intracranial extension

目的侵犯前中颅窝的晚期鼻咽纤维血管瘤手术切除后的复发率较高，其主要原因有肿瘤巨大、呈分叶状且血运丰富。本文根据经颅眶入路的手术经验及肿瘤与翼突板的解剖关系，提出颅眶入路结合鼻内镜入路治疗晚期鼻咽纤维血管瘤的方法。方法回顾1999年3月至2005年7月北京同仁医院神经外科及头颈外科的11例经颅眶入路治疗晚期鼻咽纤维血管瘤的临床资料；均为男性患者，年龄10～21岁，平均16岁；主要临床表现为鼻塞、鼻衄及鼻咽部肿物。诊断依据为CT、MRI及DSA，其平均径线为6．9cm。11例肿瘤均有颅内侵犯。经颅眶入路手术11次，其中5次联合面部切口，1次经鼻镜入路。结果肿瘤全切除8例，近全切除3例（2例蝶窦残余肿瘤）；伤口感染1例；复发1例。结论对于侵犯颅内的晚期鼻咽纤维血管瘤应先经颅眶入路，切除翼突板外侧部分肿瘤，联合鼻内镜手术切除鼻咽腔和蝶筛窦部分的肿瘤。

Objective Although deferent aggressive surgical procedure were taken to, advanced nasopharyngeal angiofibromas still has very high recurrence rate. Extensive cranial base involvement and rich blood supply accounted for the high recurrence rate. Author introduce the benefits of combined approaches by transcranio-orbital and transnasal endoscopic surgery for advanced nasopharyngeal angiofibromas. Methods Retrospective study 11 case of advanced nasopharyngeal angiofibromas underwent transcranioorbtital approaches, sex： 11 male; age： 10 -21yr. Major symptoms were nasal obstruction, epistaxia and nasal mass. Preoperative evaluations include CT, MRI, DSA. The mean size of the tumors was 6.9 （5.8 ± 9.1 ） cm. All of the tumors had intracranial invading. Results Tumor was totally removed in 8 cases, and subtotally in 3 cases（2 of residual tumors was in the sphenoid sinus）. No major complications developed. Following up were achieved in 9 cases （2 mos- 6 yr, 3 yrs in average）, tumor recurrence in 1 case. Conculsion Combined approaches by transcranio-orbital and transnasal endoscopic were effective for nasopharyngeal angiofibromas with intracranial extension.