鼻内镜下经鼻翼突径路旁中线颅底手术

doi:10.6040/j.issn.1673-3770.0.2017.115

摘要/Abstract

摘要： 内镜颅底手术中选取合适的手术径路至关重要,视野暴露良好、避免重要血管神经损伤是两大原则,相对固定的解剖参考标志也是十分必要的。在内镜下经鼻腔入路旁中线颅底手术中,翼突根部、翼管、圆孔、卵圆孔、咽鼓管圆枕等解剖结构相对固定,可以互相作为参考。内镜经鼻翼突径路可以处理翼腭窝、颞下窝、海绵窦、Meckle腔、斜坡旁至海绵窦段颈内动脉、岩斜坡区域、岩尖区、咽鼓管区域、咽旁间隙上部。加强以翼突为解剖标志的内镜颅底手术,可以增加术中辨别的标志,并能以此为中心,向内、外扩展,充分利用其空间定位,增加术者在操作中的空间立体感,有助于内镜颅底手术的扩展。

关键词: 旁中线颅底, 解剖, 鼻内镜外科手术, 翼突

Abstract: It is very important to select the appropriate surgical approach in the operation of endoscopic skull base surgery. There are two principles: (1) the field of view should be well exposed; (2) the important neurovascular injury should be avoided. In the endoscopic endonasal approach to the lateral midline skull base, the anatomical structures of the pterygoid process, the vidian canal, the foramen rotundum, the foramen ovale and the eustachian cushion are relatively fixed. By the endoscopic endonasal transpterygoid approach, we can handle the pterygopalatine fossa, infratemporal fossa, cavernous sinus, Meckle cavity, paraclival to cavernous segment of internal carotid artery, petroclival region, petrous apex, eustachian tube area, and the upper parapharyngeal space. Pterygoid process can be used as the anatomical landmark for endoscopic skull base surgery and be chosen as the operation center for inward and outward expansion. Making full use of the space location, increasing the sense in the operation of three-dimensional space, is helpful in expanding the endoscopic skull base surgery.

Key words: Pterygoid process, Anatomy, Lateral midline skull base, Endoscopic surgical procedures, operative

中图分类号:

R765.9

姜彦. 鼻内镜下经鼻翼突径路旁中线颅底手术[J]. 山东大学耳鼻喉眼学报, 2017, 31(2): 16-24.

参考文献

[1] DelGaudio JM. Endoscopic transnasal approach to the pterygopalatine fossa[J]. Arch Otolaryngol Head Neck Surg, 2003, 129(4):441-446.
[2] Alfieri A, Jho HD, Schettino R, et al. Endoscopic endonasal approach to the pterygopalatine fossa: anatomic study[J]. Neurosurgery, 2003, 52(2):374-378.
[3] 蒋卫红,肖健云.经鼻内镜颅底外科进展[J].中国耳鼻咽喉颅底外科杂志, 2015, 21(5):351-353.
[4] 张秋航,丁秀勇,王振霖.单纯耳内镜下内听道听神经瘤切除[J].中华耳鼻咽喉头颈外科杂志, 2016,51(10):726-726. ZHANG Qiuhang, DING Xiuyong, WANG Zhenlin. Exclusive endoscopic transsuprameatal approach for the pure intracanalicular acoustic neuroma[J]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2016, 51(10):726-726.
[5] Kassam A, Snyderman CH, Mintz A, et al. Expanded endonasal approach: the rostrocaudal axis. Part I.Crista galli to the sella turcica[J]. Neurosurg Focus, 2005, 19(1):E3.
[6] Kassam AB, Gardner P, Snyderman C, et al. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa[J]. Neurosurg Focus, 2005, 19(1):E6.
[7] 张秋航,刘海生,孔锋.经鼻内镜岩斜坡及颞下窝肿瘤的外科治疗[J].中华耳鼻咽喉头颈外科杂志,2005,40(7):488-492. ZHANG Qiuhang, LIU Haisheng, KONG Feng. Endoscopic endonasal surgery for tumors of petroclival region and infratemporal fossa[J]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2005, 40(7):488-492.
[8] Solari D, Villa A, De Angelis M, et al. Anatomy and surgery of the endoscopic endonasal approach to the skull base[J]. Transl Med UniSa, 2012, 2(5): 36-46.
[9] 周兵,黄谦,崔顺九,等.内镜下经鼻泪前隐窝径路切除翼腭窝及颞下窝神经鞘瘤[J].中华耳鼻咽喉头颈外科杂志, 2013, 48(10):802-806.
[10] Jacquesson T, Berhouma M, Picart T, et al. Total removal of a trigeminal schwannoma via the expanded endoscopic endonasal approach. Technical note[J]. Acta Neurochir(Wien), 2015, 157(6):935-938.
[11] 于青青,唐隽,王跃建,等. 旁中线颅底鼻内镜手术入路及其应用解剖学研究[J].中国医药科学, 2016,6(22):14-17. YU Qingqing, TANG Jun, WANG Yuejian, et al. Lateral midline skull base transnasal endoscopic approach and its applied anatomy study[J]. Chin Med Sci, 2016, 6(22): 14-17.
[12] 沈鹏,孙中武,李建瑞,等.鼻内镜下经鼻径路解剖翼腭窝区临床观察[J].山东大学耳鼻喉眼学报,2015,29(2):58-64.
[13] Hofstetter CP, Singh A, Anand VK, et al. The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, petrous apex, and the Meckel cave[J]. J Neurosurg, 2010, 113:967-974.
[14] XIAN Junfang, DU Huarui, WANG Xinyan, et al. Feasibility and value of quantitative dynamic contrast enhancement MR imaging in the evaluation of sinonasal tumors[J]. Chin Med J(Engl), 2014, 127(12):2259-2264.
[15] Yuan Y, Yue XH, Tao XF, et al. The diagnostic value of dynamic contrast- enhanced MRI for thyroid tumors[J]. Eur J Radiol, 2012, 81(11):3313-3318.
[16] 张秋航.内镜颅底外科学[J].北京:人民卫生出版社,2013.
[17] 刘剑锋,韩军,杨大章,等.内镜经翼突入路的解剖及其在处理颅底病变中的应用[J]. 中华耳鼻咽喉头颈外科杂志,2015, 50(11):909-914. LIU Jianfeng, HAN Jun, YANG Dazhang, et al. Surgical anatomy, technique and application of endoscopic endonasal transpterygoid approach in skull base surgery[J]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2015, 50(11):909-914.
[18] Fernandez-Miranda JC, Morera VA, Snyderman CH, et al. Endoscopic endonasal transclival approach to the jugular tubercle[J]. Neurosurgery, 2012, 71(1 Suppl Operative):146-158.
[19] Hofstetter CP, Singh A, Anand VK, et al. The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, pettous apex, and the Meckel cave[J]. J Neurosurg, 2010, 113(5):967-974.
[20] Raza SM, Amine MA, Anand V, et al. Endoscopic Endonasal Resection of Trigeminal Schwannomas[J]. Neurosurg Clin N Am, 2015, 26(3):473-479.
[21] Bresson D, McLaughlin N, Ditzel Filho LF, et al. Endoscopic endonasal approach for the treatment of schwannomas of the pterygopalatine fossa: Case report and review of the literature[J]. Neurochirurgie, 2014, 60(4):174-179.
[22] Szymanska A, Szymanski M, Czekajska-Chehab E, et al. Two types of lateral extension in juvenile nasopharyngeal angiofibroma: diagnostic and herapeutic management[J]. Eur Arch Otorhinolaryngol, 2015, 272(1):159-166.
[23] Rowan NR, Zwagerman NT, Heft-Neal ME, et al. Juvenile Nasal Angiofibromas: A Comparison of Modern Staging Systems in an Endoscopic Era[J]. J Neurol Surg B Skull Base, 2017, 78(1):63-67.
[24] 严波,张秋航,吕海丽,等.影像导航技术在内镜颅底外科中的应用[J].中华耳鼻咽喉头颈外科杂志,2014,49(9):726-732. YAN Bo, ZHANG Qiuhang, LÜ Haili, et al. Endoscopic skull base surgery under the guidance of image navigation technology[J]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2014, 49(9):726-732.
[25] Battaglia P, Turri-Zanoni M, Lepera D, et al. Endoscopic transnasal approaches to pterygopalatine fossa tumors[J]. Head Neck, 2016, 38 Suppl 1:E214-220.

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