侧颅底病变手术入路总结及内镜在侧颅底的应用探索

Surgical and Endoscopic Approaches for Lateral Skull Base Lesions

目的总结耳鼻咽喉科常见侧颅底病变的手术入路和我科利用耳内镜在侧颅底手术中的应用探索。方法回顾性分析我科2010年至2019年间收治的耳内镜下或者耳内镜辅助下完成的侧颅底手术患者资料,对其临床特征、手术入路及预后等进行分析总结。结果收集的侧颅底病变患者共15例,其中男性7例,女性8例,术前诊断为面肌痉挛1例,舌咽神经痛1例,术后病理确诊为岩骨胆脂瘤8例,胆固醇肉芽肿1例,听神经瘤3例,面神经瘤1例。胆固醇肉芽肿患者采用全耳内镜下手术入路,其余病例为显微镜和耳内镜联合入路。结论耳内镜技术在侧颅底手术的应用,主要集中在内听道及桥小脑角、岩尖等复杂解剖结构周围病变的清除,具有减少磨骨、近距离多角度探查优势,能实现减少不必要的损伤、保存功能、减少并发症和缩短康复时间。

Objective To report surgical and endoscopic approaches used by authors for lateral skull base lesions.Methods Data from patients admitted from 2010 to 2019 for lateral skull base surgeries using an endoscopic or combined microscopic-endoscopic approach were reviewed,including clinical characteristics,surgical approaches and treatment outcomes.Results A total of 15 patients(7 males and 8 females)were reviewed.8 patients were Pathologic diagnoses included petrous bone cholesteatoma(n=8),cholesterol granuloma(n=1),acoustic neuroma(n=3),facial nerve neuroma(n=1),hemifacial spasm(n=1)and glossopharyngeal neuralgia(n=1).Endoscopic approach was used in patients with cholesterol granuloma,while combined microscopic-endoscopic approach was used in the other patients.Conclusion In lateral skull base surgery,endoscopy can be used for lesions around the internal auditory canal,cerebellopontine angle and petrous apex,with the advantages of reducing bone resection and multi-angle views to minimize unnecessary damage,preserve function,reduce complications,and finally shorten recovery time.