侵犯颅内及海绵窦鼻咽血管纤维瘤临床研究

Clinical study for nasopharyngeal angiofi-bromas with intracranial or sinus cavernous extension

目的探讨侵犯到颅内及海绵窦的鼻咽血管纤维瘤的外科治疗。方法病例包括1988年1月至2004年1月收治的经病理证实的侵犯到颅内的鼻咽血管纤维瘤16例,11～35岁。手术方法有经口腭入路、鼻侧切开入路、上颌骨中段掀翻、颅面联合进路、下颌正中裂开联合经腭入路和上颌骨翻转入路。结果伴颅内侵犯鼻咽血管纤维瘤16例患者共行手术28次,11例为复发病变。28例次手术中11例次鼻侧切开术,颅面联合进路6例次,额颞入路2例次,经腭入路4例次,经上颌骨入路2例次,经下颌正中裂开1例次,上颌骨中段掀翻2例次。结论扩展到颅内或海绵窦的鼻咽血管纤维瘤治疗以手术彻底切除为主,上颌骨中段掀翻、颅面联合进路及经下颌正中裂开颅底进路对于侵犯到颅内或海绵窦的肿瘤暴露较好。

OBJECTIVE To evaluate the clinical feature and surgical treatment of large nasopharyngeal angiofibromas with intracranial or cavernous sinus extension. METHODS Atotal of 16 male patients were collected with a age ranged from 11 to 35 years （mean, 17.21 years）. All patients underwent resection of nasopharyngeal angiofibromas with intracranial or cavernous sinus extension. The procedure included lateral rhinotomy, craniofacial combined approach, median labiomandibulotomy combined with a trans-palatal, transmaxillary approach and middle face degloving approach. RESULTS Sixteen cases received 28 procedures. Seven patients had no recurrence but 9 patients had recurrence at least once. Twenty eight procedures include 11 times lateral rhinotomy, 6 times craniofacial combined approach, 2 times frontotemporal approach, 4 times transpalatal approach, 2 transmaxillary approach, 1 median labiomandibulotomy combined with a trans-palatal and 2 times middle face degloving approaches. CONCLUSION Radical operative resection is the main treatment method for nasopharyngeal angiofibroma with intracranial or cavernous sinus extension. The first operation recurrence rate is 8/15（53.0%） and sphenoid tumor residual may often be ignored in the operation and it is the main site of tumor recurrence. Craniofacial , median labiomandibulotomy combined with a trans-palatal and middle face degloving approaches were the best choices for large nasopharyngeal angiofibroma with intrecranial or cavernous sinus extension.