经鼻内镜治疗累及蝶窦的中颅底占位性病变

The management of space-occupying lesion of middle skull base involving sphenoid sinus by transnasal endoscopic surgery

目的:探讨累及蝶窦的中颅底占位性病变的诊断治疗方法。方法:对18例累及蝶窦的中颅底硬膜外占位病变患者施行经鼻内镜手术。结果:1例原发性空蝶鞍误诊为蝶窦囊肿,1例骨纤维异常增殖、1例脑膜瘤误诊为真菌性蝶窦炎,误诊率为16.7%。17例全部切除病变,1例大部分切除肿瘤。术中出血量100～2 500 ml。15例治愈,无并发症;1例并发细菌性脑膜炎治愈;1例双眼失明;1例因肺栓塞死亡。结论:经鼻内镜治疗蝶窦和累及蝶窦的中颅底硬膜外良性占位性病变可行。术前明确诊断、术中准确定位和仔细操作是手术成功的重要保证。

Objective：To investigate the diagnosis and therapy of space-occupying lesion of middle skull base involving sphenoid sinus.Method：A retrospective analysis was performed.Eighteen patients with extradural space-occupying lesion of middle skull base involving sphenoid sinus underwent transnasal endoscopic surgery.Result：One case of primary empty sella turcica was misdiagnosed as sphenoidal sinus cyst.One case of fibrous dysplasia and one case of meningioma were all misdiagnosed as mycotic sphenoiditis.Total rate of misdiagnosis was 16.7%.Among the 18 cases,17 cases underwent complete resection of the lesion,and only 1 case underwent major resection of the lesion.The amount of blood loss during surgery ranged between 100 ml and 2500 ml.One case had bacterial meningitis which was cured after corresponding treatment.One case was blind in both eyes.And the other case died of pulmonary embolism.Conclusion：Transnasal endoscopic surgery is feasible and practical to treat benign space-occupying lesion of sphenoidal sinus and extradural lesion of middle skull base involving sphenoidal sinus.Definite diagnosis,accurate location and careful operation are important to complete the surgery successfully.