经对侧上颌间隙入路神经内镜手术切除岩尖肿瘤

Endoscopic surgery through contralateral transmaxillary approach for patients with petrous apex tumor

目的探讨经对侧上颌间隙(CTM)入路神经内镜手术治疗颅底岩尖肿瘤的疗效。方法回顾性分析2015年1月至2020年2月经CTM入路神经内镜手术治疗的35例颅底岩尖肿瘤的临床资料。结果术后病理检查显示软骨肉瘤12例,脊索瘤11例,脑膜瘤6例,神经鞘瘤4例,蛛网膜囊肿2例。12例软骨肉瘤和11例脊索瘤中,术后24 h内CT+术后1周MRI显示,肿瘤全切除17例(73.91%),大部分切除6例;4例神经鞘瘤和2例蛛网膜囊肿均全切除;6例脑膜瘤中,5例全切除,1例次全切除。未见颈内动脉损伤。25例术中观察到脑脊液漏;5例术后发生脑脊液鼻漏;1例因鼓膜穿刺管出现脑脊液耳漏。5例术后出现新发神经缺陷或原有缺陷加重,6例术后出现暂时性上颌神经感觉迟钝或神经痛,1例发生特发性感音神经性听力损失。结论 CTM入路神经内镜手术治疗岩尖肿瘤,增加了手术的自由度和可视性,提高了肿瘤全切除率,降低了颈内动脉损伤的风险。

Objective The explore the clinical efficacy of endoscopic surgery through contralateral transmaxillary(CTM) approach for the patients with petrous apex tumor.Methods The clinical of 35 patients with petrous apex tumor who underwent endoscopic surgery through CTM approach from January 2015 to February 2020 were retrospectively analyzed.Results The postoperative pathological findings showed chondrosarcomas in 12 patients,chordomas in 11,meningiomas in 6,Schwannomas in 4 and arachnoid cysts in 2.The gross total resection of tumor was achieved in 17 patients of 23 patients with chondrosarcomas or chordoma,and in 5 patients with meningioma,in 4 patients with Schwannoma and in 2 patients with arachnoid cyst.Great partial resection of tumor was achieved in 6 patients with chondrosarcomas or chordoma and subtotal resection in 1 patient with meningioma.There was no internal carotid artery injury after the surgery.Intraoperative cerebrospinal fluid(CSF) leakage occurred in 25 patients,and postoperative CSF leakage occurred in 6 patients.New neurological defict occurred in 5 patients.Temporary maxillary nerve hypoesthesia or neuralgia occurred in6 patients.Idiopathic sensorineural hearing loss occurred in 1 patient.Conclusions For the patients with petrous apex tumor,endoscopic eurgery through CTM approach increases the freedom and visibility of surgery,improves the rate of total tumor resection,and reduces the risk of internal carotid artery injury.