影像导航引导鼻内镜下切除鼻窦-前颅底骨化纤维瘤

Resection of the ossifying fibroma of paranasal sinuses and anterior skull base with nasal endoscope under the guidance of image navigation

目的:探讨影像导航在经鼻内镜切除鼻窦-前颅底骨化纤维瘤手术中的作用。方法:选择鼻窦-前颅底骨化纤维瘤患者14例,在影像导航引导经鼻内镜下手术切除。术前后均行鼻窦CT连续扫描。CT显示所有病例均累及鼻中隔、眶纸板及筛板。10例累及额隐窝前壁,5例累及眶尖与视神经管,3例累及蝶鞍和斜坡,2例侵犯至翼腭窝。结果:所有患者均彻底切除病灶。平均手术时间280 min,影像导航配准过程平均9 min,重新配准6例。术后复查鼻窦CT均显示病变完整切除。结论:影像导航引导下经鼻内镜手术切除鼻窦-前颅底骨化纤维瘤,有助于彻底切除肿瘤并减少并发症。

Objective：To discuss the role of image navigation in resection of the ossifying fibroma of paranasal sinuses and anterior skull base with nasal endoscope.Method：Fourteen cases with ossifying fibroma involving paranasal sinuses and anterior skull base were underwent intranasal endoscopic surgery under the guidance of image navigation.Sequential nasal sinuses CT scans were obtained before and after operation.CT scans demonstrated that the nasal septum,orbital wall and anterior skull base were involved in every case.The anterior boundary of the frontal recess cells was involved in 10 cases.The lesions were adjacent to the orbital apex and optic canal in 5 cases.The sella turcica and clivus were invaded in 3 cases and the pterygopalatine fossa was invaded in 2 cases.Result：The tumors were thoroughly removed in all cases.The average operative time was 280 minutes and the average registration time of navigation was 9 minutes.Postoperation CT scans demonstrated that the tumors were totally resected.Conclusion：The image-guided endoscopic surgery of the ossifying fibroma of paranasal sinuses and anterior skull base provided accurate tumor resection,increased surgical effectiveness,decreased overall surgical complications.