Transnasal endoscopic surgery of communicating neoplasm outside cerebral dura mater and orbital fasciae
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摘要: 目的：探讨未突破眶筋膜及硬脑膜的鼻眶颅沟通瘤经鼻入路内镜手术治疗的可行性。方法：9例未突破眶筋膜及硬脑膜的鼻眶颅沟通瘤患者，颅底骨质缺损大小为1.25 cm×1.13 cm~3.25 cm×2.69 cm，经鼻入路内镜下手术治疗，均保留眼球，未进行颅底和眶内侧壁重建，用碘仿纱条填塞术腔14 d。恶性病变者术后再进行放化疗。结果：内镜下均完全切除肿瘤，术中输血1例，无眶、颅并发症，术后颅底、眶壁骨质增生自动修复缺损。术后随访2年，复发3例，其中死亡2例。结论：在一定程度上，瘤体主体在鼻腔鼻窦的鼻眶颅沟通瘤，经鼻入路内镜手术是一种安全、可靠、有效的治疗方法。Abstract: Objective: This paper is intend to observe the feasibility of surgical approach with which communicating neoplasm outside cerebral dura mater and orbital fasciae was removed by transnasal endoscopic surgery.Method: Nine patients suffered from communicating neoplasm in the area of naso-orbital-cranio complex were treated with transnasal endoscopic surgery. The size of skull base bone defect was from 1.25 cm×1.13 cm to 3.25 cm×2.69 cm. No eye enucleation was done. No reconstructions of skull base and medial wall of orbital cavity were done. Iodoform gauze was packed in paranasal sinuses fourteen days. Patients with malignant tumor were treated radiation therapy and chemical therapy after surgical treatment. The degree of resection,complications of intracranial and orbital cavities, survival condition were the focus of this study.Result: The tumor were completely removed and all operations were successfully completed by trasnasal endoscopic surgery. Only one patient was required blood transfusion due to seriously bleeding from tumor during the operation. There was no orbital, intracranial, and vascular complications. The defect of bone at skull base and lamina papyracea were automatic reconstructed. Three patients have showed recurrence of neoplasm, and two of them died during two years of following up time.Conclusion: Transnasal endoscopic surgery is a safe, reliable and effective approach to treat communicating neoplasm in the area of naso-orbital-cranio complex, of which main part of tumor exists in the sinunasal cavity.
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