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。     

伴视力减退的鼻窦黏液囊肿的临床诊断和治疗

目的:总结引起视力减退的鼻窦囊肿的临床表现和治疗要点。方法:回顾性研究2002-2010年间收治的伴有视力下降的鼻窦囊肿患者23例,其中累及额窦或额筛窦10例,单纯累及筛窦6例,累及蝶窦或蝶筛窦7例。患者常以眼部症状为主,因此大多数首诊于眼科。因蝶窦与视神经紧密相邻,蝶窦和蝶筛窦囊肿引起严重视力障碍较其他窦腔囊肿更严重。CT和MRI是确诊鼻窦黏液囊肿的重要手段。对患者实施鼻内镜手术,开放鼻窦开口,清除窦腔内囊肿及行视神经减压。术后均使用激素治疗并常规行鼻内镜复查。结果:术后所有患者眼部突出、复视、眼球运动障碍等症状好转,但视力恢复程度不一,与手术时机和视力下降严重程度有关。未及时手术者视力恢复效果较差,而视力完全丧失无光感者,即使行视神经管减压术,预后仍明显低于有残余视力者。结论:鼻内镜手术是治疗伴视力减退的鼻窦囊肿的有效手段,提高对该病的警惕和早期影像学检查对于其诊断非常重要,早期诊断和及时手术治疗是恢复患者视力的关键。     

鼻内镜下视神经减压手术疗效及影响因素分析

目的对创伤性视神经病进行鼻内镜下视神经减压术并观察其疗效及影响因素。方法对我院2003年12月～2012年12月22例创伤性视神经病患者在全麻下行鼻内镜下视神经减压术。结果 22例视神经损伤患者中,术后视力改善者8例,总有效率为36.4%,其中外伤后即出现视力丧失者16例中3例有效,外伤后视力逐渐下降者6例中5例有效;外伤后完全失明时间是预后影响因素,术中是否行鞘膜切开、外伤后进行视神经减压术的时间对疗效无显著性影响。结论创伤性视神经病是鼻内镜视神经减压的手术适应证。外伤后急剧视力下降者行视神经减压术疗效不佳;外伤后视力逐渐下降者,即使过了最佳手术治疗时期仍应积极进行手术。     

经鼻内镜颅底手术18例临床分析

目的：探讨经鼻内镜行颅底手术的可行性和临床意义。方法：回顾性分析了我科1997年～2002年在鼻内镜下完成的颅底区域手术18例的临床资料。结果：10例脑脊液鼻漏修补术均一次获得成功。8例接受视神经管减压术，术后5例视力改善。结论：经鼻内镜颅底手术简便，损伤小，安全有效，是一项值得在临床推广的操作技术，但必须掌握好这类手术的适应证。     

内镜下颅底手术体会

目的 总结内镜下颅底手术的方法和临床经验.方法 回顾性分析2003年7月～2011年8月在鼻内镜下完成的鼻颅底区域手术15例临床资料,探讨鼻颅底手术的相关技术与方法,总结临床经验.结果 15例均采用鼻内镜下进行鼻颅底手术,所有患者均取得满意疗效.其中垂体瘤7例,术后视力或内分泌症状明显改善;外伤性脑脊液鼻漏3例,修补后症状消失;外伤性视神经病5例,行视神经减压术后视力均有不同程度恢复;1例外伤性视神经病术后出现脑脊液鼻漏,经过保守治疗后痊愈.结论 经鼻内镜鼻颅底手术具有创伤小、术后恢复快、并发症少等优点.术中正确识别颅底的解剖标志、恰当的颅底修复,有助于保证手术安全,提高手术疗效.     

鼻内镜下视神经减压术治疗视神经损伤

目的：探讨鼻内镜下视神经减压术治疗视神经损伤的疗效。方法：鼻内镜下自鼻腔经筛蝶窦行视神经管减压术治疗视神经外伤10例。结果：随访6个月～4年，术前视力无光感3例术后视力无改善，有残余视力7例术后视力均有不同程度的提高，无1例发生严重的并发症。结论：鼻内镜下视神经减压术创伤小，面部无切口疤痕，是治疗视神经损伤较好的方法，患者易接受。对有残余视力的患者要尽可能地手术治疗，对无光感者手术应慎重。     

鼻外筛——蝶窦进路视神经管减压术

头面部创伤所致的视神经挫伤临床上以视神经管段损伤最为多见，本文对９例外伤性视神经挫伤病人进行鼻外筛－蝶窦进路视神经管减压术治疗，其中３例视力有所恢复，６例无效。作者认为对伤后视力下降者应作急症手术处理，以鼻外筛－蝶窦进路为最好，减压必须充分。     

视神经管减压术治疗视力损伤

目的研究视神经减压术治疗视神经管骨折所导致视力损伤的疗效.方法对20例视神经管骨折导致视力减退或丧失者,采用鼻侧切开经筛窦视神经减压术.结果术后视力恢复至0.01以上6例;恢复至有光感或手动8例,无效6例.总有效率为70%.结论采取减压手术越早,视神经恢复越好.即使术前无光感或伤后不超过15d,也不应放弃手术治疗.     

手术联合药物治疗外伤性视神经病的疗效分析

目的 评价手术联合药物治疗外伤性视神经病(traumatic optic neuropathy,TON)的疗效,分析影响临床疗效的因素.方法 对69例(70眼)确诊为TON并行鼻内镜下视神经管减压术联合药物治疗患者的临床资料作回顾分析.将入院时视力分为无光感、光感、眼前手动、眼前指数和能见标准视力表(0.02以上)5个级别,分别计为Ⅰ～Ⅴ级.入院视力Ⅰ级(无光感)者40眼,18眼因CT证实严重视神经管骨折,急诊行鼻内镜下视神经管减压术;22眼入院后先行糖皮质激素冲击治疗后再行手术治疗.入院视力I级以上者30眼,CT显示视神经管骨折的16眼行急诊手术;14眼行糖皮质激素冲击治疗3 d后行手术治疗.随访3～12个月,观察视力恢复情况.结果 入院视力有光感者疗效显著优于入院视力无光感者(90.0%比27.5%),两组疗效相比差异有统计学意义(χ2=26.98,P<0.001).入院视力Ⅰ级患眼,糖皮质激素冲击治疗后视力提高者手术疗效(80.0%)优于无改变者(5.9%),两组疗效相比差异有统计学意义(χ2=12.09,P<0.001).结论 对于无光感的患者,经药物冲击治疗后视力仍无改善者,手术疗效较差;治疗前视力是影响疗效的主要因素.影像学检查有无视神经管骨折,不应作为是否手术的决定因素.     

经鼻内镜颅底手术18例临床分析

目的:探讨经鼻内镜行颅底手术的可行性和临床意义。方法:回顾性分析了我科1997年～2002年在鼻内镜下完成的颅底区域手术18例的临床资料。结果:10例脑脊液鼻漏修补术均一次获得成功。8例接受视神经管减压术,术后5例视力改善。结论:经鼻内镜颅底手术简便,损伤小,安全有效,是一项值得在临床推广的操作技术,但必须掌握好这类手术的适应证。     

Fibrous dysplasia involving the skull base and temporal bone

OBJECTIVE: To gain a broader appreciation of the clinical presentation, operative treatment, and outcome of patients with fibrous dysplasia involving the skull base. DESIGN: Retrospective review of a clinical case series. SETTING: A single tertiary academic medical center. PATIENTS: Twenty-one patients with histopathologically confirmed fibrous dysplasia involving the skull base cared for over a 15-year-period (1983-1998). MAIN OUTCOME MEASURES: Clinical and radiographic location of the fibrous dysplasia lesions within the skull base, clinical presentation, surgical intervention, and clinical outcome were tabulated for each patient. RESULTS: The ethmoids were most commonly involved (71%), followed by the sphenoid (43%), frontal (33%), maxilla (29%), temporal (24%), parietal (14%), and occipital (5%) bones. The most common presenting features included atypical facial pain and headache, complaints referable to the sinuses, proptosis and diplopia, hearing loss, and facial numbness. Surgical treatment, guided by clinical presentation, ranged from simple biopsy with conservative follow-up to craniofacial resection. CONCLUSIONS: Fibrous dysplasia can present in myriad ways within the skull base. Modern imaging modalities and histopathologic analysis have made diagnosis relatively straightforward. Surgery, particularly in such a challenging region as the skull base, should be reserved for patients with functional impairment or a cosmetic deformity. Because of the benign nature of the condition, the surgery itself should be relatively conservative, with the primary goal being preservation of existing function.     

鼻内镜下鼻窦骨纤维异常增殖症累及颅底或眼眶的手术治疗

目的 探讨鼻内镜下鼻窦骨纤维异常增殖症累及颅底或眼眶的手术治疗与经验总结。方法 回顾性分析2017年7月—2020年12月南京大学医学院附属鼓楼医院耳鼻咽喉头颈外科收治的13例采用鼻内镜手术治疗累及颅底或眼眶的鼻窦骨纤维异常增殖症患者的临床资料,结合手术治疗及术后疗效进行综合评价。结果 13例患者术后均无严重并发症,受累颅底或眼眶病变组织彻底切除,无眼球功能障碍及脑脊液鼻漏。随访6～48个月,所有患者均无复发。结论 对于累及颅底或眼眶的鼻窦骨纤维异常增殖症的患者,鼻内镜结合导航及等离子技术可彻底切除病变组织以达到功能重建的效果。     

McCune-Albright syndrome with fibrous dysplasia of the paranasal sinuses

We report a 19-year old female patient with the McCune-Albright syndrome, which is a rare disease consisting of polyostotic fibrous dysplasia (FD) of bone associated with brown pigmented areas of the skin and several endocrine dysfunctions. The patient had FD involving the paranasal sinuses, the middle turbinate and the skull. The endocrine dysfunction of the patient concerns both growth hormone and prolactin hypersecretion. Because the patient had no major symptoms, neither surgical nor medical treatment was applied. Five-year follow-up revealed no complication and enlargement of the lesion.     

Treatment of fibrous dysplasia

BACKGROUND: The fibrous dysplasia is a rare disease of bone metabolism. Most common on the extremities, its appearance at the skull base is rare but of importance in clinical otorhinolaryngology. The patients suffer from problems such as cosmetical limitation, recurrent pain and in later phases from functional losses which result from bone dysplasia. METHODS: Based on the experiences of these cases and the study of the current literature we would like to suggest a stage dependent therapy concept that includes conservativ options as well as surgical methods which are divided into curative and palliative surgical treatments. PATIENTS: The Department of Otorhinolaryngology in Bochum has been involved in the therapy of eight patients suffering from fibrous dysplasia which have been treated and examined from six to twenty years. RESULTS: Treatment in fibrous dysplasia can be efficient in increasing quality of life. A complete healing is rare and not the main target of treatment. CONCLUSIONS: The staged therapy of fibrous dysplasia consists of conservative and surgical treatment and the combination of both. The decision for an individual therapy concept might be difficult and often requires close interdisciplinary cooperation.     

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。     

蝶枕部骨纤维异常增殖症1例并文献复习

目的:探讨颅骨的骨纤维异常增殖症的临床表现、影像学特征、病理学改变、诊断和治疗。方法:报告1例蝶枕部骨纤维异常增殖症并复习文献。结果:颅骨的骨纤维异常增殖症以头痛、眼球突出、复视甚至失明等为主诉。其CT特征为"毛玻璃样变",骨纤维畸形、硬化及黏液囊性变。病理学检查可明确诊断,而其影像学的特征性改变也可为诊断提供有力的证据。结论:颅骨的骨纤维异常增殖症临床表现多样,容易误诊,需结合临床表现、影像学及病理学检查结果进行诊断。对骨纤维异常增殖症患者手术治疗应当慎重,以保留残存的功能为首要目的。     

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。     

Computerassistierte Chirurgie (CAS) zur optimalen Behandlung der kraniofazialen fibrösen Dysplasie

BACKGROUND AND OBJECTIVE: The rare bone disease craniofacial fibrous dysplasia is only treated in cases of visible deformities of the splanchnocranium and neurocranium, compression syndromes, and delocation of nasal and paranasal drainage. METHODS AND PATIENTS: In a retrospective quality assessment analysis of six patients with craniofacial monostotic fibrous dysplasia, the indications were analysed for situations in which computer-assisted surgery (CAS) might be helpful. RESULTS AND CONCLUSIONS: CAS serves as an intraoperative basis for the assessment of cosmetic-aesthetic corrections of visible bone deformities of the splanchnocranium and neurocranium, and allows the controlled removal of pathologically affected bone in contralateral symmetry. This seems to be important, especially at the anterior skull base, as deformities of the human face produce strong psychological suffering. Furthermore, CAS allows the configuration of implants for defect reconstruction after focal restorations with bony radical surgery. Implants of various material can be prefabricated from these data, which can then be exactly fitted to cover the defect.     

Nasopharyngeal carcinoma: posttreatment changes of imaging findings

OBJECTIVE: The purpose of this study was to determine the radiologic results of nasopharyngeal carcinoma (NPC) that showed complete responses on follow-up imaging studies after radiation therapy. MATERIALS AND METHODS: This study is a retrospective review of 23 patients (18 male, 5 female, aged 15-71 years; mean age, 48.5 years) affected with NPC, from August 1995 to July 2000, who were examined with magnetic resonance imaging or computed tomography scan before and after either radical radiotherapy or chemoradiotherapy. The median follow-up was 24.7 months and ranged from 12 to 48 months. We analyzed the primary tumors by ascertaining/measuring tumor size, depth, middle ear effusion, skull base invasion, and lymphadenopathy. The treatment responses for primary tumors were classified as either atrophy, scar (asymmetric elevation without enhancement), or normalized. The tumor response and the appearance of bone regeneration in the previous destructive part of the skull base were also recorded. RESULTS: The 23 patients consisted of 12 superficial tumors, for whom treatment results were normalized in 10, atrophy in 1, and scar in 1 and 11 deep tumors for whom treatment results were scar in 6, normalized in 3, and atrophy in 2. Skull base invasion was detected in 6 patients, 5 of whom showed complete healing of skull base destruction after radiotherapy. However, the other patient exhibited an unusual hyperostotic change in the skull base mimicking fibrous dysplasia of the skull base. CONCLUSIONS: The superficial tumors tended to be radiologically normalized even when they were large. However, the deep tumors mainly changed to scar after radiation therapy. On the other hand, skull base invasion could be normalized after radiotherapy.