经鼻内镜手术治疗硬脑膜外来源的海绵窦区肿瘤

Endoscopic approaches for resection of cavernous sinus tumors from epidural origin

目的探讨经鼻内镜切除硬脑膜外来源的海绵窦肿瘤的可行性,并介绍手术入路选择、海绵窦重要结构保护和出血控制。方法硬脑膜外侵犯海绵窦的肿瘤39例,其中为垂体腺瘤17例、鼻咽纤维血管瘤5例、神经鞘膜瘤6例、脊索瘤6例、腺样囊性癌2例、软骨瘤2例、纤维肉瘤1例。根据肿瘤原发的部位和范围,分别选择内镜下经鼻中隔经蝶、扩大鼻中隔经蝶、扩大上颌窦后壁、翼突根和鼻外上颌骨等入路切除肿瘤。结果 33例肿瘤获得全切(全切率84.6%);6例肿瘤获得次全切(次全切率15.4%),无致残和致死性手术并发症。结论只要选择手术入路恰当,手术中保护海绵窦重要结构,采取合理的措施控制海绵窦出血,经鼻内镜切除硬脑膜外来源的海绵窦肿瘤是可行的。

Objective To explore the feasibility of endoscopic resection of cavernous sinus （ CS ） tumors with epidural origin, and to introduce the selection of surgical approaches, protection of CS vital structure and controlling of CS bleeding. Methods Based on the originating site and extension of the tumor, five endoscopic approaches were selected for the resection of 39 CS tumors with epidural origin, including endoscopic transseptal transsphenoidal approach, extended endoscopic transseptal transsphenoidal approach, extended transnasal transmaxillary approach, endoscopic transnasal transpterygoid approach, and extended extranasal maxillary sinus approach. Of all these 39 CS tumors, 17 were pituitary adenoma, 5 nasopharyngeal fibroangioma, 6 schwannoma, 6 ehordoma, 2 adenoid cystic carcinoma, 2 fibrosareoma, and one fibrosareoma. Results As for the surgery, total and subtotal tumor resection got achieved in 33 （84.6%） and 6 （ 15.4% ） respectively. No disabling or fatal complications occurred. Conclusion CS tumors with epidural origin can be effectively resected via endoscopic approaches. Appropriate selection of the surgical approaches, effective protection of vital CS anatomical structure, efficient reduction of CS bleeding are essential for success.