鼻内窥镜在颅底外科中的应用

Application of endoscopy in skull base surgery

目的探讨经鼻内窥镜颅底手术的治疗效果。方法内窥镜下经鼻治疗垂体腺瘤23例,颅咽管瘤2例,脑脊液鼻漏7例,蝶窦子弹异物3例,蝶窦囊肿5例,蝶窦霉菌病5例,蝶窦息肉1例,蝶筛窦腺癌1例,视神经管骨折1例,脑膜脑膨出1例。结果蝶窦囊肿、息肉和霉菌病痊愈;垂体微腺瘤和1例颅咽管瘤全切;侵袭性腺瘤、1例颅咽管瘤和蝶筛窦腺癌部分切除;视神经骨管骨折视力提高0.2;脑脊液鼻漏全部治愈,1例术后并发脑膜炎;蝶窦异物2例取出,失败1例。结论经鼻内窥镜颅底手术,定位准确,操作简单,安全有效,但有一定的适应症,须严格掌握与选择。

PURPOSE The primary objective of this study is to present an alternative technique to the management of some skull base lesions.METHODS Forty nine patients were managed under endoscope who suffered from cerebrospinal rhinorrhea, pituitary adenomas, craniopharyngioma and sphenoidal diseases,et al.RESULTS In 49 cases of the skull base lesion, forty surgeries were successful. One patient developed an acute meningitis. Three patients developed the adhesion of nasal cavity.CONCLUSION The endoscope has the advantage of improved visualization, angled view, and a wide panoramic perspective. The transnasal endoscopic technique is a safe, effective, minimally invasive approach. But there are disadvantages such as lacking of binocular vision, and subsequent lacking of operative field s depth. Surgeons should understand its feasibility, limitation and indication.