累及鼻颅底区域鼻腔鼻窦骨源性良性肿瘤的鼻内镜手术治疗

目的 探讨包括骨瘤、骨化纤维瘤、骨纤维异常增殖症在内的累及鼻颅底区域鼻腔鼻窦骨源性良性肿瘤鼻内镜手术治疗策略。 方法 经鼻内镜治疗鼻腔鼻窦骨源性良性肿瘤140例,包括骨瘤116 例,骨化纤维瘤14例,骨纤维异常增殖10例。手术方式包括:单纯鼻内镜手术95例,影像导航辅助鼻内镜手术24例,鼻内镜联合鼻外入路21例。 结果 患者均顺利完成手术,未发生严重并发症。骨瘤均彻底切除。骨化纤维瘤12例得到彻底切除,2例有病变残留。骨纤维异常增殖症10例采取姑息性手术,术后面部外观得以恢复,病变对周围组织地压迫症状得以缓解。术后随访6~36个月,骨瘤术后无复发,骨化纤维瘤术后复发2例,骨纤维异常增殖症1例术后视力无改善,其余患者症状得到不同程度的缓解。 结论 骨瘤、骨化纤维瘤及骨纤维异常增殖是鼻窦常见的良性纤维骨性病变。三者临床症状相似。高分辨率CT和(或)MRI是早期诊断的重要手段。影像导航引导鼻内镜并必要时联合鼻外入路手术是治疗该类疾病的有效方法。手术时机及手术方式的选择应依据病变类型、患者症状、肿瘤位置及范围综合考虑。     

鼻内镜手术治疗鼻-眶-颅底骨纤维异常增殖症4例

目的 探讨鼻内镜手术治疗鼻-眶-颅底骨纤维异常增殖症的方法及预后。方法 回顾分析4例经鼻内镜手术治疗的累及鼻腔鼻窦、眼眶、颅底的骨纤维异常增殖症的临床资料。其中男1例, 女3例, 5～17岁, 中位年龄13岁。临床表现为鼻塞、头痛、流涕、嗅觉减退, 其中1例伴双眼视力下降。病变累及筛骨4例, 蝶骨2例, 额骨2例, 上颌骨2例, 颧骨、颞骨、枕骨1例。结果 4例均在鼻内镜下经鼻将病变组织大部分切除。随访13～123个月, 鼻塞、头痛、流涕均逐渐消失, 嗅觉好转, 鼻腔黏膜上皮化良好。1例视力下降者术后视力略有好转, 但4年后视力再次下降行二次手术。4例均未出现手术并发症, 效果满意。结论 鼻内镜手术治疗鼻-眶-颅底骨纤维异常增殖症安全、有效, 损伤小, 不仅可以恢复鼻腔鼻窦生理功能、改善临床症状, 而且对预防及治疗并发症也有积极作用。     

手术治疗鼻窦-颅底区域良性纤维骨性病变

目的:探讨采用经鼻内镜和开放式手术入路治疗鼻窦-颅底区域纤维骨性病变的方法、注意事项及临床疗效。方法:15例鼻窦-颅底区域纤维骨性病变,其中骨瘤6例,骨化纤维瘤2例,骨纤维异常增殖7例。回顾3种病变的病理及CT影像特点,根据病变的位置及范围选择内镜或开放手术入路治疗。采用鼻内镜手术11例,其中单鼻入路7例,双鼻扩大入路4例;开放式手术4例,其中单纯眉弓入路1例,双冠状入路3例。结果:术后随访2个月～4年,病变完全切除10例,无复发;部分切除5例,都是骨纤维异常增殖症。全部患者临床症状及面部畸形消失或较术前明显改善。内镜手术中发生脑脊液鼻漏1例,Ⅰ期修复成功。术前复视3例,2例半年后消失,1例减轻。全部患者无眶内及颅内并发症。结论:手术是治疗临床症状明显的良性鼻窦-颅底区域纤维骨性病变的有效手段。病变位置和范围是决定采用开放式手术还是经鼻内镜入路的决定因素。内镜手术可切除由额窦后壁到斜坡的中线颅底广泛区域内的病变,而开放式手术入路可以处理眶内壁以外前颅底的病变。无论采用何种入路,骨瘤、骨化纤维瘤可作到完全切除。骨纤维异常增殖由于病变广泛且有自限性,故手术以减轻临床症状和改善面部畸形为目的,多行部分切除。即使骨纤...     

鼻腔鼻窦骨良性病变累及眼眶的鼻内镜手术

目的探讨累及眼眶的鼻腔鼻窦骨良性病变鼻内镜下手术处理方法,分析手术运用特点、手术并发症及疗效。方法回顾性分析南京大学医学院附属鼓楼医院耳鼻咽喉科2014年1月—2018年7月收治的13例累及眼眶的骨良性病变,其中骨瘤7例,骨纤维异常增殖症4例,骨化纤维瘤2例。2例筛窦骨瘤突入眶内,其余11例均有眶壁不同程度受累。所有患者均经鼻内镜手术,部分患者结合运用影像导航技术、鼻中隔开窗及泪前隐窝入路手术,术中准确定位病变界限,对突入眶内病变及受累的眶组织予以彻底切除。所有手术操作均以保护并不突破眶筋膜为原则,除1例突入眶内巨大筛骨骨瘤外,其余术毕均未予眶壁重建处理。结果所有患者均经鼻内镜完成手术,受累眶壁及眶内骨性病变均切除彻底。5例患者术后第1天出现眶周轻度肿胀,取出鼻腔填充物后消除,无眼球功能障碍。术后复查CT显示眶内解剖结构及位置正常。随访11～65个月,所有患者均无复发。相关鼻窦引流通畅、上皮化良好,无远期并发症。结论彻底切除骨良性病变的眶受累解剖结构有利于减少术后复发,鼻眼相关解剖及手术视野和操作角度是手术成功的要点,经鼻内镜手术处理累及眼眶的骨性病变具有微创和疗效好等优势。     

影像导航辅助鼻内镜下治疗鼻窦骨纤维异常增殖症的应用体会

目的:探讨影像导航辅助鼻内镜下切除鼻窦骨纤维异常增殖症的手术方法及经验。方法:回顾性分析2006-03-2011-12期间收治的4例鼻窦骨纤维异常增殖症患者,其中男2例,女2例;年龄19～55岁,平均38岁。原发于上颌窦内3例,原发于蝶窦内1例。术前行16排CT扫描并行三维重建,全部病例均采用影像导航鼻内镜下电钻磨除鼻窦腔内的异常骨纤维组织,实现骨纤腔内的轮廓化。结果:4例患者均在影像导航鼻内镜下准确找到病变并磨除大部分病变组织。3例患者术后头痛、鼻塞、面部不适等症状逐渐消失。1例上颌窦内骨纤维异常增生患者术后3个月再次出现面部肿胀疼痛,保守治疗效果不佳,复查CT示左侧上颌窦炎,再次行手术,术中发现上颌窦内有大量骨渣,考虑为首次手术后术腔未冲洗干净,导致上颌窦口堵塞,再次扩大上颌窦口,冲洗上颌窦腔,术后行鼻腔及上颌窦冲洗,1个月后症状完全消失。所有患者术后均未见复发。结论:正确的使用影像导航系统辅助鼻内镜下治疗鼻窦骨纤维异常增殖症,术中结合电钻磨除鼻窦腔内的异常骨纤维组织,实现骨纤腔内的轮廓化,可以使患者获得彻底、安全、有效的治疗。     

鼻窦骨纤维异常增殖症36例临床分析

目的 探讨鼻窦骨纤维异常增殖症的临床特征、手术方法及预后。 方法 回顾性分析南京医科大学第一附属医院2009年10月至2016年10月收治的36例鼻窦骨纤维异常增殖症患者的临床资料。所有患者均根据术前影像学结果制定手术方案:其中经鼻内镜鼻窦手术18例,传统Caldwell-Luc径路4例,鼻侧切开术7例,鼻内镜联合Caldwell-Luc径路4例,冠状切口颅骨切开术3例,冠状切口联合Caldwell-Luc径路2例。3例患者同时行鼻内镜下视神经管减压术。所有患者中28例行病变骨质彻底切除,8例行改善功能与外观的保守切除。 结果 36例平均随访6个月至5年,2例复发,余34例恢复良好。患者术后并发脑脊液鼻漏2例,颅内血肿1例。 结论 鼻窦骨纤维异常增殖症临床表现复杂,手术切除病变骨质是主要治疗方式,应在尽可能保留功能及外观的前提下,根据术前影像学检查及患者诉求个性化制定手术径路。该病症预后良好,较少复发及出现恶变。     

12例鼻窦-颅底骨肿瘤样病变的病理与临床分析

目的探讨鼻窦-颅底骨肿瘤样病变的病理特征、临床表现及治疗方法,提高对此类病变的诊治水平。方法回顾性分析12例鼻窦-颅底骨肿瘤样病变的影像学特征、病理及临床资料。其中行鼻内镜下手术5例、鼻外眶上眉弓切口术2例、鼻侧切开术1例,颅面联合径路切除2例;2例仅行活检术。结果鼻窦-颅底骨肿瘤样变中骨瘤6例、骨化纤维瘤2例、骨纤维异常增殖症2例、软骨瘤1例、骨母细胞性骨肉瘤1例。临床表现以头痛及眼部受压症状多见。1 0例手术患者1年后复查,其中1例骨化纤维瘤及1例骨纤维异常增殖症病灶有残留但无增大;1例软骨瘤复发并恶变为软骨肉瘤;7例患者病灶完全切除无复发。2例仅行活检者中1例失访,1例病灶无明显变化。结论病理特征结合影像学检查进行分析是诊断该类病变的重要方法,手术是重要的治疗手段。     

鼻内镜下筛窦骨瘤切除15例临床分析

目的 报告鼻内镜下筛窦骨瘤切除15例，探讨鼻内镜下筛窦骨瘤切除的手术方法及治疗效果，总结鼻窦骨瘤的手术经验。方法 回顾性分析武汉市第一医院耳鼻咽喉头颈外科2018年6月—2022年4月行鼻内镜下筛窦骨瘤切除术的15例患者的临床资料，所有患者术前均行鼻窦CT检查、鼻内镜检查、鼻阻力检查及眼科相关检查。手术均于全身麻醉鼻内镜下完成，根据CT确定筛窦骨瘤的位置和范围后确定具体的手术方式，完整切除筛窦骨瘤，术后门诊定期复诊，复查鼻窦CT、鼻内镜。结果 15例患者术后病理均证实为筛窦骨瘤，鼻窦CT显示筛窦骨瘤均彻底切除，随访5~48个月，患者术后鼻塞、面部胀痛、头痛、流脓涕、嗅觉减退等症状较术前减轻或消失，未发生明显眶内、颅内并发症，未见骨瘤复发。结论 术前鼻窦CT可确定骨瘤位置及范围，为鼻内镜手术提供良好保障，鼻内镜下筛窦骨瘤切除有效、安全、微创，预后良好，值得临床推广应用。     

影像导航引导鼻内镜下切除鼻窦-前颅底骨化纤维瘤

目的:探讨影像导航在经鼻内镜切除鼻窦-前颅底骨化纤维瘤手术中的作用.方法:选择鼻窦-前颅底骨化纤维瘤患者14例,在影像导航引导经鼻内镜下手术切除.术前后均行鼻窦CT连续扫描.CT显示所有病例均累及鼻中隔、眶纸板及筛板.10例累及额隐窝前壁,5例累及眶尖与视神经管,3例累及蝶鞍和斜坡,2例侵犯至翼腭窝.结果:所有患者均彻底切除病灶.平均手术时间280 min,影像导航配准过程平均9 min,重新配准6例.术后复查鼻窦CT均显示病变完整切除.结论:影像导航引导下经鼻内镜手术切除鼻窦-前颅底骨化纤维瘤,有助于彻底切除肿瘤并减少并发症.     

经鼻内镜治疗累及蝶窦的中颅底占位性病变

目的：探讨累及蝶窦的中颅底占位性病变的诊断治疗方法。方法：对18例累及蝶窦的中颅底硬膜外占位病变患者施行经鼻内镜手术。结果：1例原发性空蝶鞍误诊为蝶窦囊肿,1例骨纤维异常增殖、1例脑膜瘤误诊为真菌性蝶窦炎,误诊率为16.7%。17例全部切除病变,1例大部分切除肿瘤。术中出血量100～2 500 ml。15例治愈,无并发症;1例并发细菌性脑膜炎治愈;1例双眼失明;1例因肺栓塞死亡。结论：经鼻内镜治疗蝶窦和累及蝶窦的中颅底硬膜外良性占位性病变可行。术前明确诊断、术中准确定位和仔细操作是手术成功的重要保证。     

Endoscopic resection of ossifying fibroma involving paranasal sinuses and the skull base in a series of 15 cases

Conclusion: The key technical challenges in the resection of OFs are rapid removal of tumors by image-guided navigation, determining the boundary of the resection and the proper control of blood supply through the anterior or posterior ethmoidal arteries.

Objective: This study aimed to analyze the clinical data of adult patients with paranasal ossifying fibromas involving the anterior skull base and orbit. The surgical technique and indications are also discussed.

Methods: This study reviewed the clinical data of 15 patients (age >16 years) who underwent resection of paranasal ossifying fibromas involving the anterior skull base and orbit by endoscopic surgery with an image guidance system between October 2006 and October 2014.

Results: The mean age of the 15 patients was 33.2 years (range?=?16–58 years). All tumors were completely resected via endoscopic surgery. Intra-operative cerebrospinal fluid (CSF) leaks (four cases) were repaired endoscopically. The mean follow-up duration was 43.1 months. One patient lost vision after surgery, recurrence was observed in two patients, one underwent a third excision 8 years after the second surgery, and the other exhibited residual osteoarthritis 3 years after the first surgery and remained under regular observation. One patient was lost to follow-up.     

Craniofacial resection for malignant nasal and paranasal sinus tumors assisted with the endoscope

Background

Craniofacial resection is regarded as the treatment of choice for paranasal malignant tumors invading the skull base. Even with this approach, the surgical view remains obscured when tumors in the deep nasal and paranasal sinuses are resected. Endoscopy provides a wide and clear surgical view in the deep and narrow nasal cavity. We report two patients who underwent craniofacial resection assisted with endoscope.

Methods

Two patients with malignant paranasal sinus tumor invading the anterior skull base underwent endoscope-assisted craniofacial resection.

Results

To avoid a limited surgical view in the sinonasal cavity, we performed craniofacial resection with endoscopic osteotomy and several procedures in the nasal cavity. The neurosurgeon performed anterior skull base osteotomy at an appropriate site from above, while the otolaryngologist provided illumination with the endoscope from below and preserved the adjacent structures. The patients recovered uneventfully and the endoscopic examinations of both patients 18 months after the surgery showed no recurrence.

Conclusions

Endoscopes were useful for the craniofacial resection at osteotomy, providing illumination from below and at the several procedures in the deep part of the nasal cavity. If a lateral rhinotomy incision is made, the combined transfacial and transnasal approaches avoid the limited working angle associated with the transnasal approach alone. Although an endoscopic approach is useful for treating sinonasal tumors, we should recognize its advantages and limitations.     

Endoscopic treatment of nasolacrimal sac obstruction secondary to fibrous dysplasia of paranasal sinuses

Fibrous dysplasia involving paranasal sinuses mostly has asymptomatic features, but sometimes may cause signs and symptoms which relate to the location and extent of bony abnormalities. The use of endoscopic nasal surgery for debulking ethmoidal fibrous dysplasia, blocking the left nasolacrimal sac and simultaneous intranasal endoscopic dacryocystorhinostomy with silicone intubation is presented. The procedure and advantages of endoscopic approach over the external approach are outlined in this paper.     

Juvenile psammomatoid ossifying fibroma in paranasal sinus and skull base

Conclusion: The endoscopic transnasal approach with IGS is a safe and effective technique, allowing completely resection of JPOF, with minimal morbidity and recurrence.

Objectives: JPOF is a benign but locally aggressive fibro-osseous lesion. This study presents a series of JPOF cases, involving anterior skull base and orbit, treated by endoscopic transnasal approach with image guidance system (IGS) to resect the mass completely.

Method: This study retrospectively reviewed the clinical presentations, surgical procedures, and complications of 11 patients with JPOF who were treated by endoscopic approach from May 2009 to April 2014. All patients were followed by endoscopic and CT scan evaluations during follow-up.

Results: All of the 11 cases were boys, with a mean age of 11.8 years (range?=?6–17 years). The size of mass in the paranasal sinus ranged from 2.5–4.6?cm in greatest dimension (mean?=?3.7?cm), and the medial orbital wall and cranial base were involved in all patients. All 11 patients received successful operation and were relieved from symptoms without mortality and major complications. During follow-up (range from 17–67 months; mean follow-up?=?25.8 months), only one patient was recurrent in local position. The skull base partial resected during surgery was found to rebuild after 1 year.     

Paget's disease and fibrous dysplasia

Paget's disease and fibrous dysplasia are benign disorders that can involve the temporal bone and skull base. They commonly lead to otolaryngologic symptoms such as impingement of cranial nerves or the orbit or blockage of the external auditory canal or paranasal sinuses, although they can often be a challenge to diagnose because of their insidious presentation. Their benign nature and common presentation within the difficult-to-access confines of the skull base should lead the clinician to exercise caution in their treatment, reserving surgical intervention for either diagnosis or the relief of symptoms. As a better understanding of the etiology of these conditions develops and new pharmacotherapeutic agents are tested, it is likely that physicians will be able to turn to medical rather than surgical techniques to treat these disorders.     

经鼻内镜手术治疗鼻腔鼻窦骨源性良性肿瘤——附14例报告

目的探讨经鼻内镜手术治疗鼻腔鼻窦骨源性肿瘤的可行性及手术技巧。方法回顾性分析1998年6月-2012年5月经鼻内镜手术治疗的14例鼻腔鼻窦骨源性肿瘤的临床资料。所有患者均于术前行鼻窦高分辨CT（HRCT）检查,确定肿瘤的位置和侵犯范围。手术均在全身麻醉下进行,经鼻内镜手术11例,鼻内镜辅助鼻外径路手术3例。其中行肿瘤彻底切除9例,部分切除5例。结果所有患者术后平均随访5年7个月。2例侵及眶内及前颅窝的骨化纤维瘤患者分别于术后2个月和8个月复发,接受第2次手术后1例病变基本控制,目前仍在随访中,另1例去外院接受了第3次鼻颅脑联合手术再复发,仍在观察中;1例骨母细胞瘤患者采用经鼻经额联合径路内镜手术,但侵入前颅窝相当于鸡冠处的肿瘤仍有残留,术后2年患者因左侧眶内及颅内肿物复发去外院行开颅手术后失访;其余患者随访至今未见复发。所有病例均未发生其他严重并发症。结论鼻腔鼻窦骨源性肿瘤局限于鼻腔鼻窦者经鼻内镜手术可彻底切除;但当肿瘤破坏颅底突入颅腔或肿瘤侵及颈内动脉、视神经等重要结构时,单纯内镜下肿瘤不易彻底切除,需多学科的联合手术或其他辅助治疗。     

鼻腔鼻窦腺样囊性癌的临床分析

目的 探讨鼻腔鼻窦腺样囊性癌(ACC)的临床特点及手术疗效分析。方法 回顾性分析云南省第三人民医院2010年6月—2017年6月收治的31例病理确诊为鼻腔鼻窦ACC患者主要临床表现及生物学特性,针对不同部位、分期患者进行不同方式的手术及术后放疗。结果 31例鼻腔鼻窦ACC患者随访30例,1例失访;3年生存率为87.1%(27/31),5年生存率为71.0%(22/31),3年局部复发率为16.2%(5/31),5年局部复发率为25.8%(8/31)。结论 鼻腔鼻窦ACC生长部位深在,毗邻结构复杂,肿瘤的高侵袭性和沿神经浸润生长的习性,手术彻底切除较难,易复发。传统手术结合鼻内镜颅底技术以及神经追踪技术是减少复发、提高生存率的有效方法。     

Mucoceles de senos paranasales. Nuestra experiencia en 72 pacientes

IntroductionTraditional treatment for paranasal sinuses mucoceles recommended total removal through external approaches. Since the 90 s, endoscopic marsupialization has been proposed as optimal surgical treatment. We present our experience in the treatment of this pathology.Material and methodA retrospective review of 72 patients treated for paranasal sinuses mucoceles between 1980 and 2006 in our ENT department was performed. We describe clinical features, surgical approaches employed and recurrence of disease.ResultsThe sample was composed of 72 patients with average follow-up period of 44 months (range 13–214 months). A total of 81 mucoceles were presented, with 44% affecting the frontal sinus or frontoethmoidal cells, followed in frequency by maxillary sinus mucoceles (35%). Twenty-nine percent of the patients did not present predisposing factors; 31% of patients had a history of nasal polyposis, 35% had undergone previous sinus surgery and 14% suffered previous facial fractures; 48 mucoceles patients were treated endoscopically and 33 were treated with external or combined approaches. Recurrence was found in 7 patients, 2 in the endoscopic surgery group and 5 in the external/combined surgery group.ConclusionsEndoscopic marsupialization is a safe approach with a low rate of recurrence. The endoscopic approach may be unsuitable for frontal lateral sinus mucoceles or those with significant bone blockage.