CAJ | 학술논문

目的通过内镜经鼻经翼突入路解剖研究获得相关解剖标志,总结应用该径路处理蝶骨翼突周围颅底病变的经验.方法 2例(4侧)成人尸头经血管硅胶灌注后,行导航CT扫描后进行手术入路解剖,拍摄获得高清图像.回顾性分析内镜经鼻经翼突入路治疗的12例颅底病变患者的临床资料.其中蝶窦侧隐窝自发性脑脊液鼻漏3例;翼腭窝、颞下窝神经鞘瘤2例,神经纤维瘤2例;中颅窝颞下窝沟通皮样囊肿1例、颅底侵袭性真菌病1例、上咽旁间隙基底细胞腺瘤1例;腺样囊性癌1例、颅底软骨肉瘤1例.结果在入路解剖方面,获得该入路的一些重要解剖标志,如蝶腭孔及其内容物、翼管及其内容物、三叉神经上颌支及圆孔、三叉神经下颌支和卵圆孔、咽鼓管翼突部等.3例自发性脑脊液鼻漏患者一次性修补成功;4例翼腭窝、颞下窝神经来源的良性肿瘤患者术中全切,术后随访10～120个月无复发.颅底皮样囊肿、颅底侵袭性真菌病、上咽旁间隙基底细胞腺瘤患者,病变全切,随访13～84个月无复发.颅底软骨肉瘤患者术中肿瘤大部分切除,术后放化疗,肿瘤控制;腺样囊性癌患者,术中肿瘤全切,术后随访5年复发,再次手术.除2例术后短期出现腭部麻木感觉异常外,无其他并发症.结论掌握翼突入路的解剖标志对于处理翼突周围的颅底病变有重要意义.内镜经鼻经翼突入路是处理部分翼突周围颅底病变的安全有效的技术.
목적 통과내경경비경익돌입로해부연구획득상관해부표지,총결응용해경로처리접골익돌주위로저병변적경험.방법 2례(4측)성인시두경혈관규효관주후,행도항CT소묘후진행수술입로해부,박섭획득고청도상.회고성분석내경경비경익돌입로치료적12례로저병변환자적림상자료.기중접두측은와자발성뇌척액비루3례;익악와、섭하와신경초류2례,신경섬유류2례;중로와섭하와구통피양낭종1례、로저침습성진균병1례、상인방간극기저세포선류1례;선양낭성암1례、로저연골육류1례.결과 재입로해부방면,획득해입로적일사중요해부표지,여접악공급기내용물、익관급기내용물、삼차신경상합지급원공、삼차신경하합지화란원공、인고관익돌부등.3례자발성뇌척액비루환자일차성수보성공;4례익악와、섭하와신경래원적량성종류환자술중전절,술후수방10～120개월무복발.로저피양낭종、로저침습성진균병、상인방간극기저세포선류환자,병변전절,수방13～84개월무복발.로저연골육류환자술중종류대부분절제,술후방화료,종류공제;선양낭성암환자,술중종류전절,술후수방5년복발,재차수술.제2례술후단기출현악부마목감각이상외,무기타병발증.결론 장악익돌입로적해부표지대우처리익돌주위적로저병변유중요의의.내경경비경익돌입로시처리부분익돌주위로저병변적안전유효적기술.
Objective To identify the landmarks of transpterygoid approach and to report its application in a series of cases.Methods Two silicon-injected adult cadaveric heads (4 sides) were dissected by performing an endoscopic endonasal transpterygoid approach after CT scanning for imaging guidance.High-quality pictures were obtained.This approach was used to treat twelve patients with skull base lesions including 3 spontaneous cerebrospinal fluid (CSF) leaks in the lateral recess of the sphenoid sinus, 2 neurofibromas and 2 Schwannomas involving the pterygopalatine fossa and infratemporal fossa, 1 dermoid cyst involving the middle fossa and infratemporal fossa, 1 invasive fungal sinusitis invading the middle fossa base, 1 basal cell adenoma in the upper parapharyngeal space, 1 chondrosarcoma in the parasellar region and 1 adenoid cystic carcinoma.Clinical records were reviewed.Results In terms of approach dissection, important landmarks, such as the sphenopalatine foramen and artery, vidian canal and nerve, foramen rotundum and maxillary branch of trigeminal nerve, foramen ovale and mandibular branch of trigeminal nerve, as well as pterygoid segment of Eustachian tube were identified.In terms of clinical data, three patients with spontaneous CSF leak underwent repair.Six patients with benign lesions underwent complete tumor resection.In the patient with invasive fungal disease, thorough debridement was undertaken and antifungal drug was administered for one month.For these benign skull base lesions, there was no recurrence during the follow-up period.In the patient with chondrosarcoma, most of the tumor was removed in the first operation, and was followed by two endoscopic operations because of fast growth of the tumor.Final control was achieved with chemotherapy and radiation.In the patient with adenoid cystic carcinoma, tumor recurred five years after surgery, and was reoperated.Conclusion An understanding of the landmarks of the transpterygoid approach is paramount for surgically dealing with disease located within and adjacent to the region of the pterygoid process of the sphenoid bone.The endoscopic endonasal transpterygoid approach is feasible and safe in selected patients with skull base lesions.