影像导航辅助鼻内镜下筛窦骨瘤切除术

Endoscopic removal of ethmoid osteomas under navigation guidance

目的探讨影像导航辅助鼻内镜下切除筛窦骨瘤的微创治疗技术。方法回顾性分析烟台毓璜顶医院耳鼻咽喉头颈外科2005年4月至2009年10月筛窦骨瘤患者19例，其中男15例，女4例；年龄14～67岁，中位数37岁。术前行16排cT扫描并行三维重建，全部病例采用影像导航鼻内镜下手术切除治疗。结果19例患者均在影像导航鼻内镜下成功切除了骨瘤，其中1例联合眉弓切口，1例联合唇龈切口切除肿瘤，余17例全部通过鼻腔切除。肿瘤直径≤2cm且局限于筛窦的5例患者在影像导航鼻内镜下直接切除骨瘤；肿瘤直径〉2em且基底部较窄的2例患者在影像导航引导下切断蒂部，将肿瘤推入口腔取出；肿瘤基底部宽，与前中颅底、纸样板、眶尖、视神经管、眼眶骨质等部分或广泛相连、融合的12例患者在影像导航引导下采用虫蚀样电钻逐渐磨除肿瘤。所有病例术后随访8～64个月，全部病例术后头痛、鼻塞、流脓涕、面部不适等症状逐渐消失；1例复视患者术后1个月复视逐渐消失；2例面部隆起者，1例术后消失，1例好转。2例同时做了鸡冠切除，术后嗅觉丧失，分别随访9个月和26个月嗅觉未恢复；1例切除鸡冠者术后出现脑脊液鼻漏，行2次鼻内镜下修复手术后痊愈。结论影像导航鼻内镜下手术适用于中线生长和局限于筛窦内的骨瘤，该术式切除准确、安全、微创，CT扫描是术前评估及制定正确治疗方案的保障。

Objective To investigate the minimally-invasive ablation of osteomas of the ethmoid sinuses endonasally. Methods A retrospective analysis was done in 19 patients （15 male, 4 female, aged between 14 -67, medium 37 ） diagnosed as osteomas of ethmoid sinuses hospitalized from April 2005 to Ocotober 2009. All patients underwent sixteen-detector row computed tomography scan and 3D reconstruction preoperatively. All underwent operation with the help of navigation system and nasal endoscope. Results The ethmoid osteoma in all 19 patients was removed successfully with endoscope and navigation system. Two open procedures（ 1 through superciliary arch incision and 1 through labiogingival incision） were performed to assist the removal of the tumor, 17 tumors were removed under endoscopic and navigation guidance. In 5 patients whose osteoma was localized or with the diameter no more than 2 cm, these osteomas were removed endonasally with the help of navigation system. The osteomas in 2 patients was found to have narrow basilar part and relatively dissociative were removed from oral cavity after abscising the basilar part. The osteomas in 12 patients were found to have basilar part connected with ante-meso skull base, lamina papyracea, orbital apex, cranalis opticus, fossa orbitalis bone, these osteomas were removed using electric drill with the guidance of navigation system. All patients were followed up from 8 to 64 months, and were asymptomatic （1 patient who suffered from ambiopia had the sysmptom disappered, 2 patients suffered from prosopo-eminencce, 1 patient was asymptomatic and 1 patient was feeling better）. Two patients underwent removal of crista galli, 1 of them suffered from postoperative cerebro-spinal rhinorrhea, and recovered after endoscopic repairing procedure and iodoform gauze packing and recovered 15 days later. Two patients who underwent removal of crista galli suffered from anodmia and never recovered after 9 and 26 months follow-up. One patient with enormous osteoma suffered from repeated crusting and abnomal odor, and recovered after nasal flushing. Conclusions Endoscopic ablation of osteomas of the ethmoid sinuses with the guidance ofnavigation system is an accurate, secure, minimally-invasive procedure. Osteomas on median line and localized in ethmoid sinus is an indication of this operation. Preoperative CT scan is a safeguard for an accurate operation.