Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (6): 42-48.doi: 10.6040/j.issn.1673-3770.0.2020.094

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Clinical analysis of the endonasal transpterygoid approach to the resection of malignant tumors involving the middle skull base of 30 cases

ZHENG Chaopan1, ZENG Xiaoyan1, ZHANG Bo1, HAN Lin1, LUO Man2, MA Lingguo1   

  1. 1. Department of Otolaryngology, Shenzhen People Hospital, Shenzhen 518020, Guangdong, China;
    2. Shenzhen Healthcare Committee Office, Shenzhen 518000, Guangdong, China
  • Published:2021-01-11

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Abstract: Objective To explore the endonasal transpterygoid approach to the resection of malignant tumors involving the middle skull base and its outcomes. Methods The surgery-related data of 30 cases of malignant tumors involving the middle skull base attended to at the Department of Otorhinolaryngology of the Shenzhen People's Hospital between October 2012 and June 2019 were retrospectively analyzed. The skills and experience of the surgeons and the techniques employed during the surgery were summarized. The Kaplan-Meier method was used for survival analysis. The prognoses of the tumor-involved internal carotid arteries were also explored. Results The surgeries, using the endonasal transpterygoid approach, were performed under general anesthesia; the average duration of surgery was 145 minutes, the average intraoperative blood loss was 470 mL, and intraoperative cerebrospinal fluid leakage occurred in 6 cases. The postoperative intracranial infection in 2 cases and the cerebrospinal fluid leakage in 1 case were cured. Pathologically, there were 21 cases of recurrent nasopharyngeal carcinoma, 3 cases of adenoid cystic carcinoma, 2 cases of mucoepidermoid carcinoma, 1 case of chordoma, 1 case of carcinosarcoma, 1 case of nasopharyngeal follicular dendritic cell sarcoma, and 1 case of skull base lymphocytic epithelioma-like carcinoma. The 1-year, 2-year, 3-year, and 5-year survival rates of the 30 patients with malignant tumors were 92.9%, 79.6%, 48.6%, and 36.5%, respectively. The median survival duration was 29.00(35.00, 23.00)months for recurrent nasopharyngeal carcinoma and 38.00(38.00, 38.00)months for other malignant tumors. The survival curves of recurrent nasopharyngeal carcinomas and other malignant tumors showed statistical significance(χ2=4.248; P=0.039). The median durations of survival of patients with and without internal carotid artery invasion were 16.00(23.00, 14.00)and 36.00(80.00, 31.00)months, respectively, and their survival curves were significantly different(χ2=9.421; P=0.002). Internal carotid artery involvement is a risk factor for poor prognosis, and the risk of death of patients with internal carotid artery involvement was 9.678 times that of those without involvement(HR=9.678, P=0.011). Conclusion The endoscopic transpterygoid approach is a reasonable option for the surgical treatment of tumors involving the middle skull base; however, the involvement of the internal carotid artery is an important prognostic factor that should always be considered.

Key words: Middle skull base, Malignant tumor, Endoscope, Transpterygoid approach, Internal carotid artery

CLC Number: 

  • R765.9
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