内镜下经鼻腔鼻窦入路切除D型三叉神经鞘瘤的临床效果  

Endoscopic resection of type D trigeminal schwannoma through nasal sinus approach

作　　者：冯昕[1] 付强[1] 谷少尉 叶萍[1] 王娟[1] 段晨[1] 蔡晓岚[1] 张立强[1] 倪石磊[2] 李学忠[1] Feng Xin;Fu Qiang;Gu Shaowei;Ye Ping;Wang Juan;Duan Chen;Cai Xiaolan;Zhang Liqiang;Ni Shilei;Li Xuezhong(Department of Otorhinolaryngology,Qilu Hospital of Shandong University,National Health Commission Key Laboratory of Otorhinolaryngology(Shandong University),Jinan 250012,China;Department of Neurosurgery,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院耳鼻咽喉科、国家卫生健康委员会耳鼻喉科学重点实验室(山东大学),济南250012 [2]山东大学齐鲁医院神经外科,济南250012

出　　处：《中华外科杂志》2023年第3期232-238,共7页Chinese Journal of Surgery

基　　金：国家自然科学基金(82171106,81700890);山东省自然科学基金(ZR2021MH117);泰山学者工程专项经费(tsqn202103166)。

摘　　要：目的探讨单纯内镜下经鼻腔鼻窦入路切除D型三叉神经鞘瘤的可行性和手术入路。方法回顾性分析2014年12月至2021年8月在山东大学齐鲁医院耳鼻咽喉科接受手术治疗的11例D型三叉神经鞘瘤患者的临床资料。男性7例,女性4例,年龄(47.5±13.5)岁(范围:12~64岁)。肿瘤累及翼腭窝、颞下窝、筛窦、蝶窦、海绵窦等结构,部分突入中颅窝,大小为1.6 cm×2.0 cm×2.0 cm~5.7 cm×6.0 cm×6.0 cm。全身麻醉下内镜经鼻切除肿瘤,入路包括翼突入路4例,泪前隐窝入路4例,扩大泪前隐窝入路2例,鼻腔外侧壁入路1例。术后观察肿瘤复发情况和主要临床症状恢复情况。结果所有手术在单纯内镜下经鼻腔鼻窦完成,10例一期全切除,1例因肿瘤巨大,操作空间小,未能实现全切。1例同时切除同侧腮腺区面神经颧支来源及枕部的神经鞘瘤。2例巨大肿瘤切除后中颅底硬脑膜广泛暴露,其中1例并发脑脊液漏,取中鼻甲游离黏膜瓣修补,1例取自体脂肪进行填塞加固。手术时间[M(IQR)]180(160)min(范围:120~485 min),无严重手术并发症及死亡。术后随访58(68)个月(范围:10~90个月),10例全切除患者无肿瘤复发,所有患者面部外形无明显改变。结论单纯内镜下经鼻腔鼻窦,并根据肿瘤大小及累及范围选择合适的入路可较好地切除累及翼腭窝、颞下窝及周围区域的D型三叉神经鞘瘤。Objective To examine the feasibility and surgical approach of removing type D trigeminal schwannoma through nasal cavity and nasal sinus under endoscope.Methods Eleven patients with trigeminal schwannoma who were treated in the Department of Otorhinolaryngology,Qilu Hospital of Shandong University from December 2014 to August 2021 were analyzed retrospectively in this study.There were 7 males and 4 females,aged(47.5±13.5)years(range:12 to 64 years).The neoplasm involved the pterygopalatine fossa,infratemporal fossa,ethmoidal sinus,sphenoid sinus,cavernous sinus,and middle cranial fossa.The size of tumors were between 1.6 cm×2.0 cm×2.0 cm and 5.7 cm×6.0 cm×6.0 cm.Under general anesthesia,the tumors were resected through the transpterygoid approach in 4 cases,through the prelacrimal recess approach in 4 cases,through the extended prelacrimal recess approach in 2 cases,and through the endoscopic medial maxillectomy approach in 1 case.The nasal endoscopy and imaging examination were conducted to detect whether neoplasm recurred or not,and the main clinical symptoms during follow-up.Results All the surgical procedures were performed under endonasal endoscope,including Gross total resection in 10 patients.The tumor of a 12-year-old patient was not resected completely due to huge tumor size and limited operation space.One patient was accompanied by two other schwannomas located in the occipital region and the ipsilateral parotid gland region originating from the zygomatic branch of the facial nerve,both of which were removed concurrently.After tumor resection,the dura mater of middle cranial fossa was directly exposed in the nasal sinus in 2 cases,including 1 case accompanied by cerebrospinal fluid leakage which was reconstructed by a free mucosal flap obtained from the middle turbinate,the other case was packed by the autologous fat to protect the dura mater.The operation time was(M(IQR))180(160)minutes(range:120 to 485 minutes).No complications and deaths were observed.No recurrence was observed in the 10 patient

关 键 词：神经鞘瘤 内窥镜检查 三叉神经 手术入路 

分 类 号：R739.4[医药卫生—肿瘤]