鼻腔解剖变异对神经内镜经鼻蝶窦入路的影响

Affect of endonasal anatomical variations to endoscopic endonasal transsphenoidal approach

目的调查鼻腔解剖变异的发生频率并评价这些变异在神经内镜经鼻蝶窦入路手术中的影响。方法回顾性分析2010-03-28-2013-10-30北京大学人民医院神经外科收治的采用神经内镜经鼻蝶窦入路手术治疗的30例患者的临床资料,记录内镜下所见的鼻腔解剖变异,并评估其对手术进程的影响。结果 30例患者中无功能性垂体腺瘤16例,泌乳素腺瘤10例,生长激素腺瘤2例,蝶窦脓肿1例,骨软骨瘤1例。30例患者中46.67%(14/30)存在鼻腔解剖变异。其主要变异类型为鼻中隔偏曲8例和中鼻甲肥大3例,其他变异包括棘状中隔1例,粘连1例,中鼻甲气泡1例。14例存在鼻腔解剖变异患者中1例因鼻中隔严重弯曲改为对侧鼻孔入路,1例由耳鼻喉科医师行鼻甲部分切除手术,其余12例通过电凝鼻粘膜使之萎缩,剪断粘连带,将中鼻甲向外侧推移必要时折断等方法使得蝶窦开口显露清晰从而手术顺利进行。全部患者中2例发生了与鼻内手术阶段相关但与鼻腔解剖变异无关的并发症。结论尽管鼻腔解剖变异广泛存在,但随着对鼻腔解剖结构的熟练掌握和手术操作经验的增加,这些变异并不能对神经内镜经蝶窦入路手术造成影响。

OBJECTIVE To investigate the frequency of endonasal anatomical variations and to evaluate whether these variations hinder the progress of endoscopic endonasai transsphenoidal approach （EETA） or require other rhinologi- cal surgical skills. METHODS The clinical data and endonasal anatomical variations of the 30 patients with sellar lesion treated with EETA in Department of Neurosurgery of Peking university People＇s Hospital from March 28,2010 to Octo- ber 10,2013 were analyzed retrospectively. The relevance of these variations for the progress of surgery was evaluated. RESULTS A total of 30 patients with sellar lesion treated with EETA were enrolled,including 16 cases non-functioning ademoma,10 cases prolactin adenoma, 2 cases GH adenoma, 1 case sphenoid sinus abscess, 1 case osteochondroma, and 46.67 % （14/30） cases of them had endonasal anatomical variations. The majorities of variation were septum deviation and middle turbinate hypertrophy,which were 8 cases and 3 cases respectively. Other variations included spina septi 1 case, synechia 1 case, bullous middle turbinate 1 case. in all 14 patients with variation, 1 patient converted to contralateral nostril approach due to severe septum deviation, 1 patient received middle turbinate ablation by otolaryngologist, the remainder 12 patients＇ operation proceeded smoothly with appropriate management by neurosurgeon, no case aborted as endonasal anatomical variations. Complications related to the endonasal phase but not related with anatomical variation occurred in 2 cases. Statistical analysis showed that nasal anatomical variations do not affect the operation process and complications. CONCLUSION Although endonasal anatomical variations are frequent,they do not pose a relevant obstacle for EETA by experienced neurosurgeon with good master about nasal anatomy.