内镜翼突入路治疗中颅底良性占位性病变

The management of benign space-occupying lesion of the middle skull base via the endoscopic pterygopalatine space approaches

目的探讨鼻内镜下翼突入路切除中颅底病变的适应证和手术方法。方法回顾分析深圳市人民医院耳鼻咽喉科2011年5月至2014年12月收治的9例经鼻内镜翼突入路手术切除中颅底良性病变的临床资料,其中神经鞘瘤3例,蝶旁囊肿2例,肉芽肿性血管炎1例,炎性假瘤1例,纤维血管瘤1例,骨纤维异常增殖综合征1例。随访4~36个月。结果 9例均成功手术切除,随访期内无复发。5例术后上颌神经分布区域出现麻木感,3例出现鼻腔干燥症状,随后逐渐减轻。患者术后均无脑脊液鼻漏、脑膜炎等症状。结论经鼻内镜翼突入路手术切除颅底占位性病变能够达到微创手术切除良性肿瘤的要求。

Objective To discuss the surgical technique and indications of benign space-occupying lesion of the middle skull base via the endoscopic pterygopalatine space approaches. Methods Nine patients with benign space-occupying lesions of the middle skull base operated via the endoscopic pterygopalatine space approaches from May 2011 to December 2014 were retrospectively analyzed. The lesions included 3 schwannoma,2 parasphenoide sinus cyst,1 granulomatous vasculitis,1 inflammatory pseudotumor,1 fibroangioma and 1 fibrous dysplasia. Results The lesions were all removed. No recurrence happened during a 17-month follow-up on the average. There was no occurrence of cerebrospinal fluid rhinorrhea or meningitis in all patients. Five patients had obvious numbness in the maxillary nerve innervation area and 3 patients had mycteroxerosis after the operation,but these symptoms disappeared afterwards. Conclusion The management of benign space-occupying lesion of the middle skull base via the endoscopic pterygopalatine space approaches was reliable with minimal invasion and total removal of some benign lesions.