内镜下经鼻泪前隐窝入路切除翼腭窝及颞下窝神经鞘瘤  

Removal of Schwannoma in the pterygopalatine and infratemperal fossa via endoscopic prelacrimal recess approach

作　　者：周兵[1] 黄谦[1] 崔顺九[1] 王成硕[1] 李云川[1] 于振坤[1,2] 陈晓红[1] 叶婷[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科教育部耳鼻咽喉头颈科学重点实验室(首都医科大学),100730 [2]南京同仁医院耳鼻咽喉头颈外科

出　　处：《中华耳鼻咽喉头颈外科杂志》2013年第10期802-806,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：北京市卫生系统高层次人才专项经费资助（2009-3-36）

摘　　要：目的 分析和讨论经鼻内镜下泪前隐窝入路,经上颌窦后外侧壁切除累及翼腭窝及颢下窝神经鞘瘤手术结果,探讨手术方法及适应证.方法 病例资料来自2004年至2011年住院接受经鼻内镜下泪前隐窝入路翼腭窝和颞下窝神经鞘瘤切除手术患者6例,其中男性和女性各3例,年龄29 ～ 59岁.手术前主要接受鼻窦CT扫描和MRI检查.采用全身麻醉下经鼻内镜下泪前隐窝入路进入翼腭窝和颞下窝.手术后组织病理学确认为神经鞘瘤.术后定期CT或MRI检查随访观察.结果 6例患者实现手术完整切除.平均随访19.3个月无复发,有3例在术后第1～2周出现面部上颌神经分布区域较明显麻木感,随后逐渐减轻,仅1例随访终期遗留术侧口角轻度麻木.结论 内镜下经鼻开放泪前隐窝入路切除翼腭窝和颞下窝神经鞘瘤,完整保留鼻腔外侧壁,损伤小,并发症少,为经鼻进入翼腭窝和颞下窝的创新微创入路.Objective To sum up and analyze the results of surgical removal of Schwannoma in the pterygopalatine and infratemperal fossa （PPF and ITF） through postero-lateral wall via prelacrimal recess approach （PLRA）. The surgical technique and indications were presented and discussed. Methods Six patients aged from 29 - 59 year-old with Schwannoma in the PPF and ITF, who received the tumor resection via PLRA under endoscope, were enrolled in this paper. Three were female and 3 were male. All of them received preoperative CT and MRI. The PPF and ITF were approached via prelacrimal recess endoscopically under general anesthesia. Schwannoma was histopathologically confirmed after surgery. The postoperative periodical CT and MRI follow up was conducted. Results The tumors were removed completely in these 6 patients. No recurrence was found during 19. 3 months follow up on the average. Three patients had obvious numbness in the V2 innervation area 1 or 2 weeks after operation and disappeared afterwards. Only 1 patient had mild altercation numbness at the end of follow up. Conclusions Schwannoma involved PPF and ITF can be removed endoscopically via PLRA. The lateral wall of nasal cavity might be kept intact. It is a novel minimally transnasal invasive approach to PPF and ITF with less damage and complications.

关 键 词：神经鞘瘤 颅底肿瘤 内窥镜检查 耳鼻喉外科手术 翼腭窝 

分 类 号：R739.91[医药卫生—肿瘤]