鼻内镜下切除鼻腔鼻窦内翻性乳头状瘤的临床分析

目的探讨经鼻内镜手术切除鼻腔鼻窦内翻性乳头状瘤的疗效。方法对2002年6月～2007年6月笔者所在医院在鼻内镜下切除鼻腔鼻窦内翻性乳头状瘤11例患者和同期行鼻侧切开术治疗鼻腔鼻窦内翻性乳头状瘤11例患者进行回顾性比较研究。所有患者系Ⅰ期和Ⅱ期病例。结果在鼻内镜下治疗的11例患者中,10例一次性手术完全切除,1例15个月复发再手术治愈。在鼻侧切开术下治疗的11例患者中1例恶变,6例一次性手术完全切除,2例术后发现残留,予以微波处理,2例分别手术后6个月和12个月复发,均再手术治愈。所有病例均随访3年,均未再复发。结论内镜下切除鼻腔鼻窦内翻性乳头状瘤,具有视野清晰、损伤小、面部无瘢痕、患者康复快,术后换药方便等特点。     

颅面联合根治术的护理

颅面联合根治术是将面颅的肿瘤连同受侵犯的颅骨及脑膜、脑组织整块切除,并修补和重建颅骨及硬脑膜。我院自1986年9月起,对筛窦癌和鼻腔恶性混合瘤侵犯颅内各1例病人,施行前颅凹进路颅面联合根治术。初期效果良好。现报告护理体会如下: 例1 男,55岁,患筛窦癌二个月收入院,左眼突出,视力尚可,鼻根部轻度隆起,左鼻腔中鼻道以上有一肿物,表面粗糙,质脆易出血。X线显示:筛窦区密度增高,蜂房消失,左眶上缘骨白线消失,左上颌窦密度增高,其周围窦壁完整。活检报告:低分化鳞癌。行颅面联合根治及左眶内容物剜除术。恢复良好。     

颅底肿瘤的显微外科手术治疗

目的：报道颅底肿瘤显微外科手术治疗的临床疗效。方法：回顾分析显微外科手术治疗颅底肿瘤26例的临床特点总结手术。结果：26例颅底肿瘤中，手术全切除22例，次全切除4例，死亡2例，术后随访到24例，脑神经损害或症状加重3例，其余病例全部好转或冷痊愈，全切除的病例术后3－6个月及1年复查MRI均未见肿瘤复发。结论：眶上入路和眶颅颧入路是前、中颅底肿瘤较理想的手术径路，颅中、后窝肿瘤的手术治疗应把经岩骨乙状突前入路作为主要选择，颅底和硬脑膜重 颅底手术成败的关键。     

额部半冠状切口额肌骨膜瓣修复前颅底

随着颅底外科的发展,位于鼻腔、鼻窦、眼眶等部位的肿瘤或病变侵犯前颅底,皆行颅面或颅颌面联合进路行病变整块切除术[1].对于颅底缺损的修复办法,国内外学者已做了各种各样的尝试.近几年,笔者对前颅底小缺损,使用额部半冠状切口额肌骨膜瓣修复,效果理想.现报告如下.     

颅面联合径路颅鼻沟通瘤切除术围术期护理

总结8例采用颅面联合径路切除累及前颅底或颅内脑组织的鼻腔、鼻窦肿瘤手术患者的护理。认为术前给予针对性的心理护理，可保证手术的顺利实施；术后加强病情监护，密切观察意识状态及瞳孔的变化，加强呼吸道管理，做好口腔、鼻腔及眼护理，积极进行并发症的预防、观察和护理干预，能促进患者康复。     

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

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(6...     

颅面联合径路颅鼻沟通瘤切除术围术期护理

总结8例采用颅面联合径路切除累及前颅底或颅内脑组织的鼻腔、鼻窦肿瘤手术患者的护理.认为术前给予针对性的心理护理,可保证手术的顺利实施;术后加强病情监护,密切观察意识状态及瞳孔的变化,加强呼吸道管理,做好口腔、鼻腔及眼护理,积极进行并发症的预防、观察和护理干预,能促进患者康复.     

经颅显微外科手术切除垂体腺瘤

报道经颅显微外科切除垂体腺瘤２８例，选择额下、翼点、额－颞联合三种不同术式入路和显微手术技巧。所有病例术前接受ＣＴ或／和ＭＲＩ扫描检查，经颅内路应用显微外科技术对肿瘤施行全切除。肿瘤全切除２０例，次全切除８例，无手术死亡。术后平均２年以上随访无肿瘤复发。认为肿瘤鞍上部分较大或瘤块向鞍上周围伸展，经颅入路是较理想的途径。     

面中部翻揭梨状孔进路行鼻咽部手术的护理

经面中部翻揭梨状孔进路行鼻咽部手术具有径路短、视野宽、切除彻底,鼻腔功能损害少,不损面容的特点。我科1984年9月至1991年10月,采用此进路为54例,鼻咽部患者施行手术,效果满意。现将护理报告如下: 临床资料本组54例中,男43例,女11例,年龄18～62岁。诊断:鼻息肉9例,鼻腔巨大结石1例,创伤性鼻中隔偏曲合并鼻歪1例,鼻腔良性肿瘤12例,鼻腔恶性肿瘤8例,鼻咽部良性肿瘤8例,筛窦囊肿2例,筛窦血管内皮瘤1例,上颌窦癌6例,脑脊液鼻漏3例,鼻肉脑膜脑膨出2例,脑垂体瘤1例。全组病例手术顺利,创口一期愈合,面容无损,无重大合并症。护理体会     

鼻内镜联合显微镜经鼻腔蝶窦及中颅窝手术

目的探讨鼻内镜下经鼻腔直接入路行蝶窦及中颅窝手术的方法. 方法鼻内镜下经较宽大一侧鼻腔将中鼻甲向外推移,鼻腔扩张器扩大视野,直达并开放蝶窦前壁, 鼻内镜与显微镜联合切除病变. 结果 10例孤立性蝶窦炎术后症状消失.6例蝶窦囊肿、脑膜瘤均一次手术切除.32例垂体腺瘤17例全切除,12例次全切除,3例大部分切除,术后补充X刀治疗.48例术后随访6个月～3.5年,平均2.5年,蝶窦囊肿、蝶窦炎、脑膜瘤无复发,3例垂体腺瘤复发,无颅内感染并发症,无鼻腔粘连、鼻出血等鼻腔并发症. 结论鼻内镜联合显微镜经鼻腔蝶窦及中颅窝手术损伤小、出血少、手术时间短、效果好.     

Frontal skull base surgery combined with endonasal endoscopic sinus surgery

BACKGROUND: Postoperative infection remains a serious complication after radical resection of anterior skull base lesions because intracranial, nasal, and paranasal cavities are opened during surgery. To prevent complications from postoperative infection, we combined endonasal endoscopic sinus surgery (ESS) with the frontal transbasal approach in patients with skull base lesions. METHODS: Patients (n = 16) with anterior skull base lesions extending to the paranasal or nasal cavity underwent surgical resection via the frontal transbasal approach. After removal of the lesion via the transcranial approach, enlargement of the ostium or sinusotomy was performed bilaterally using our endonasal ESS procedure. The main purpose of ESS is the establishment of a wide drainage route to avoid dead space and postoperative infection. Furthermore, we confirmed the absence of residual lesion and leakage of cerebrospinal fluid (CSF), endoscopically. RESULTS: The frontal transbasal approach combined with endonasal ESS was performed in 16 patients with frontal skull base lesions. There were 8 malignant tumors, 6 benign tumors, and 2 mucoceles. Although 11 patients had preoperative active paranasal sinusitis, most frequently at the ethmoid sinus, none experienced postoperative infection. There was no complication related to ESS procedure. Furthermore, leakage of CSF and extracranial residual tumor were not found. CONCLUSION: Endonasal ESS after frontal skull base surgery is a highly useful technique for preventing postoperative infection, especially for the cases with large skull base tumors extending into other regions involving the paranasal sinuses or nasal cavity and with active paranasal sinusitis.     

Zones of approach for craniofacial resection: minimizing facial incisions for resection of anterior cranial base and paranasal sinus tumors

OBJECTIVE: Anterior cranial base tumors are surgically resected with combined craniofacial approaches that frequently involve disfiguring facial incisions and facial osteotomies. The authors outline three operative zones of the anterior cranial base and paranasal sinuses in which tumors can be resected with three standard surgical approaches that minimize transfacial incisions and extensive facial osteotomies. METHODS: The zones were defined by performing dissections on 10 cadaveric heads and by evaluating radiographic images of patients with anterior cranial base tumors. The three approaches performed on each cadaver were transbasal, transmaxillary, and extended transsphenoidal. RESULTS: Three zones of approach were defined for accessing tumors of the anterior cranial base, nasal cavity, and paranasal sinuses. Zone 1 is exposed by the transbasal approach, which is limited anteriorly by the supraorbital rim, posteriorly by the optic chiasm and clivus, inferiorly by the palate, and laterally by the medial orbital walls. This approach allows access to the entire anterior cranial base, nasal cavity, and the majority of maxillary sinuses. The limitation imposed by the orbits results in a blind spot in the superolateral extent of the maxillary sinus. Zone 2 is exposed by a sublabial maxillotomy approach and accesses the entire maxillary sinus, including the superolateral blind spot and the ipsilateral anterior cavernous sinus. However, access to the anterior cranial base is limited. Zone 3 is exposed by the transsphenoidal approach. This approach accesses the midline structures but is limited by the lateral nasal walls and intracavernous carotid arteries. An extended transsphenoidal approach allows further exposure to the anterior cranial base, clivus, or cavernous sinuses. The use of the endoscope facilitates tumor resection in the nasal cavity and paranasal sinuses. CONCLUSION: The operative zones outlined offer minimally invasive craniofacial approaches to accessing lesions of the anterior cranial base and paranasal sinuses, obviating facial incisions and facial osteotomies. Case illustrations demonstrating the approach selection paradigm are presented.     

Tumors of the paranasal sinuses: a therapeutic challenge

Cancer involving the ethmoid and sphenoid frontal sinus complex can be successfully eradicated by a combined transcranial and transfacial surgical dissection. Survival rates of 44 to 58 percent with a 3 percent hospital mortality rate in patients whose previous surgery or radiotherapy was largely unsuccessful suggest that this cosmetically acceptable surgical endeavor should be used more often by the head and neck surgeon in treating paranasal sinus cancer. Utilizing the principles of antibiotic prophylaxis, strict attention to principles of tumor removal and surgical technique, and the talents of the combined surgical and neurosurgical team, this aggressive surgical approach to the paranasal sinuses can be safely and successfully carried out. The approach described herein has the following advantages: it allows accurate evaluation of intracranial tumor extension while protecting the intracranial contents, it essentially avoids cerebrospinal fistulization, it provides adequate exposure for hemostasis, facilitates en bloc tumor resection, selectively conserves the orbital contents, and provides patient survival rates up to 58 percent for paranasal cancer that involves the ethmoid and sphenoid frontal sinus complex.     

Endoscopic treatment of benign tumors of the nose and paranasal sinuses.

OBJECTIVE: The endoscopic approach can be successfully employed for the treatment of benign tumors such as fibroosseus and vascular lesions, pleomorphic adenomas, gliomas, and schwannomas. STUDY DESIGN AND SETTING: Nineteen patients diagnosed with benign tumors of the nasal cavity and paranasal sinuses and treated using an endoscopic approach were retrospectively reviewed. The endoscopic approach was used exclusively in 15 cases and was associated with an external approach in 4 cases (due to an intracranial extension of the tumor in 3 patients and its location at the level of the anterior wall of the frontal sinus in the last case). RESULTS: The resection of the lesions was radical in 18 patients and subtotal in 1 case. The mean follow-up was 27 months and only 1 recurrence (5%) was observed in the juvenile angiofibroma group 20 months postoperatively. CONCLUSION: and significance In selected cases, endoscopic surgery can be considered an effective treatment for the resection of benign tumors involving the sinonasal tract.     

Case of frontal sinus carcinoma for which anterior skull base surgery was performed: application for resection of orbita

Carcinoma of the nasal cavity and paranasal sinuses occupies only 3% of head and neck malignant tumors in the West, but 10% in Japan. Frontal sinus carcinoma is much rarer, occupying less than 1% of carcinoma of the nasal cavity and paranasal sinuses. In Japan, only 38 cases have been reported for 40 years, from 1924 to 1964. Almost all patients died within one year because only facial resection was performed. We report a case of frontal sinus carcinoma (squamous cell carcinoma) invasive the to skull base for which we performed anterior skull base surgery and can confirm two years survival in our institution. In this case, resection of the right orbit contents was performed, but careful consideration must be given to resection and repair of orbit contents for maintaining a patient's quality of life. Not only computed tomography scan and magnetic resonance imaging but also angiography is thought to be useful, especially for the ophthalmic artery (in this case, the lacrimal artery) is important.     

Malignant solitary fibrous tumor of the nasal cavity.

Solitary fibrous tumors (SFTs) are unusual mesenchymal tumors that were first described as primary spindle-cell neoplasms of the pleura. These tumors have been described in many other locations, including the urogenital system, orbit, mediastinum, and upper respiratory tract. Twenty-two cases of an SFT of the paranasal sinuses and nasal cavity have been reported, but none described a malignant SFT extending through the anterior skull base. A 70-year-old man had a 6-month history of unilateral left-sided epiphora and nasal obstruction. Computed tomography and magnetic resonance imaging showed a large left-sided nasal cavity mass with extension into the left extraconal orbit and intracranial extension through the left cribriform plate and ethmoid roof. The patient underwent preoperative embolization of the internal maxillary artery and a subsequent anterior craniofacial resection via a midfacial degloving approach and a left anterior craniotomy. Histopathological analysis of the specimen was consistent with a malignant SFT.     

Midline anterior craniofacial approach for malignancy: results of en bloc versus piecemeal resections

Thirty consecutive cases of midline anterior craniofacial procedures for the treatment of malignant neoplasms arising from the paranasal sinuses were reviewed. Posterior and lateral base craniofacial procedures were specifically excluded. This review compares the results, in terms of survival and major complication rate, between en bloc and piecemeal resections. The average follow-up was 4 years and 3 months. Sixteen patients were treated with an en bloc resection. The major complication rate was 31%. One-year survival rate was 94% for the en bloc resection group, 67% for patients with positive margins, and 100% for patients with clear margins. Three-year survival for en bloc resection dropped to 56, 33, and 67%, respectively. Fourteen patients were treated with piecemeal resections. The major complication rate was 21%. One-year survival rate was 83% for the piecemeal resection group, 60% for patients with positive margins, and 100% for patients with clear margins. Three-year survival dropped to 70, 60, and 80%, respectively. Although it is considered desirable to obtain an en bloc resection in some craniofacial procedures, we conclude that a piecemeal resection is a viable alternative in situations where an en bloc procedure is difficult to obtain safely.     

Midline Anterior Craniofacial Approach for Malignancy: Results of En Bloc Versus Piecemeal Resections

Thirty consecutive cases of midline anterior craniofacial procedures for the treatment of malignant neoplasms arising from the paranasal sinuses were reviewed. Posterior and lateral base craniofacial procedures were specifically excluded. This review compares the results, in terms of survival and major complication rate, between en bloc and piecemeal resections. The average follow-up was 4 years and 3 months. Sixteen patients were treated with an en bloc resection. The major complication rate was 31%. One-year survival rate was 94% for the en bloc resection group, 67% for patients with positive margins, and 100% for patients with clear margins. Three-year survival for en bloc resection dropped to 56, 33, and 67%, respectively. Fourteen patients were treated with piecemeal resections. The major complication rate was 21%. One-year survival rate was 83% for the piecemeal resection group, 60% for patients with positive margins, and 100% for patients with clear margins. Three-year survival dropped to 70, 60, and 80%, respectively. Although it is considered desirable to obtain an en bloc resection in some craniofacial procedures, we conclude that a piecemeal resection is a viable alternative in situations where an en bloc procedure is difficult to obtain safely.     

Surgical resection of calvarial metastases overlying dural sinuses

OBJECTIVE: Few reports have addressed the surgical management of cranial metastases that overlie or invade the dural venous sinuses. To examine the role of surgery in the treatment of dural sinus calvarial metastases, we reviewed retrospectively 13 patients who were treated with surgery at the University of Texas M.D. Anderson Cancer Center between 1993 and 1999. We compared them with 14 patients who had calvarial metastases that did not involve a venous sinus. METHODS: Clinical charts, radiological studies, pathological findings, and operative reports were analyzed retrospectively. RESULTS: The median age of patients with dural sinus calvarial metastases was 54 years. Nine patients were men and four were women. Renal cell carcinoma and sarcoma were the most common primary tumors. Similar features were noted in the 14 patients with nonsinus calvarial metastases. Of the 13 dural sinus calvarial metastases, 11 involved the superior sagittal sinus, and 2 involved the transverse sinus. In nine patients, the involved sinus was resected, and in four patients, the sinus was reconstituted after tumor removal. Nine patients in the dural sinus calvarial metastases group received en bloc resection, and four received piecemeal resection. No operative deaths occurred. The overall median actuarial survival was 16.5 months. The survival times of the two groups were comparable. In the group with dural sinus calvarial metastases, transient postoperative neurological deficits occurred in two patients (15%), and a permanent deficit occurred in one patient (8%). No patients in the group with nonsinus calvarial metastases experienced deficits after resection. Compared with piecemeal resection, en bloc resection was associated with significantly less blood loss. CONCLUSION: Complete extirpation of calvarial metastases that overlie or invade a dural sinus can be achieved with only slightly more morbidity than complete removal of calvarial metastases that are located away from the sinuses. En bloc resection is as safe as piecemeal resection and is more effective in limiting operative blood loss. The overall recurrence and survival rates of patients with dural sinus calvarial metastases are similar to those of patients with calvarial metastases that do not involve the sinuses. Therefore, involvement of a dural venous sinus should not discourage resection of calvarial metastases. In carefully selected cancer patients, surgery provides effective palliation of symptomatic calvarial metastases that overlie or invade the venous sinuses.     

Video-assisted thoracic surgery resection of chest wall en bloc for lung carcinoma

A video-assisted thoracic surgery approach to en bloc resection of lung cancer invading the chest wall is described. Using a minimally invasive surgical approach combined with neoadjuvant external beam radiotherapy, complete resection of an upper lobe carcinoma invading two rib segments was performed in a manner that permitted complete resection with curative intent and allowed for rapid recovery.