鼻内镜下鼻腔径路治疗孤立性蝶窦囊肿16例

孤立性蝶窦囊肿临床报道较少,近年来随着CT及MRI等影像学检查的应用以及鼻内镜技术的开展,对该病的诊断和治疗有了长足的进展。我科1997年1月~2002年6月经鼻内镜下鼻腔径路治疗孤立性蝶窦囊肿16例,现报道如下。1资料与方法1.1临床资料16例孤立性蝶窦囊肿病人中,男10例,女6例;年龄19~72岁,平均38.3岁。左侧10例,右侧5例,双侧1例。临床表现:①以头痛为主诉者12例。头痛部位无特异性,其中8例以头痛为唯一症状,3例以头痛首诊于神经科。②视力改变7例。表现为复视、视力减退者4例,眼球运动障碍、眼球外突者2例,流泪1例。③鼻部症状7例。表现为…     

鼻内镜下经鼻行蝶窦及垂体手术

鼻内镜手术的广泛开展和影像技术的进步,鼻内镜下手术治疗蝶窦及中颅窝病变逐渐增多。蝶窦及垂体病变经鼻进路手术,既往多采用经鼻中隔或经筛窦开放蝶窦,虽然手术视野能满足需要,但仍然存在创伤大。出血多,破坏鼻腔正常结构的缺点。2000年1月～2004年1月我们采用鼻内镜下经鼻腔直接入路行蝶窦及垂体手术,效果良好,现报告如下。     

鼻内镜下蝶窦开放术治疗蝶窦霉菌病15例

鼻真菌病是鼻科临床常见的一种感染性疾病,近年来鼻腔及鼻窦真菌病的发病率有上升的趋势。笔者自1999年12月～2001年12月在两地两个不同的医院共收治15例蝶窦霉菌病病人,经鼻内镜行蝶窦开放术治疗,取得了较好的疗效,报道如下。1一般资料1.1临床资料 15例病人中,男8例,女7例,年龄35～58岁。15例中患侧头面部及眶周胀痛7例,血涕8例,2例病人有眼球突     

鼻内镜下治疗蝶窦非垂体源性病变53例

目的:探讨蝶窦非垂体源性病变的诊断及鼻内镜治疗方法。方法:53例蝶窦非垂体源性病变患者均经CT扫描发现蝶鞍区病变并提示了病变范围。8例局限性病变者经蝶窦前壁自然口入路完成手术,2例鼻咽纤维瘤侵犯蝶窦者经鼻中隔中线入路,其余经上鼻道或蝶筛入路暴露病变。结果:53例蝶窦非垂体源性病变中,蝶窦囊肿及脓囊肿23例、蝶窦真菌感染8例、蝶窦出血性息肉2例、垂体瘤切除术后蝶窦炎性肉芽肿1例、蝶窦乳头状瘤5例、蝶窦脑脊液鼻漏1例、蝶窦骨化纤维瘤2例、鼻咽血管纤维瘤侵犯蝶窦2例、筛蝶窦脑膜瘤1例均行鼻内镜下蝶窦开放切除病变或修补脑膜,术后症状明显改善;蝶窦内血肿并颈内动脉假性动脉瘤3例仅作鼻内镜检查,经DSA证实并行血管内介入栓塞治疗后治愈;蝶窦恶性肿瘤3例,经蝶筛入路切除蝶窦内大部分肿瘤后辅以放化疗;鼻咽癌侵犯蝶窦2例病理检查证实后行放化疗。结论:蝶窦鞍区病变以头痛、眼部症状为常见症状,CT、MRI及DSA检查对蝶窦病变的及早发现和诊断起着重要作用,鼻内镜下处理蝶窦病变径路多样,选择适当径路可达到直接、安全、微创等目的。     

鼻内镜下经鼻腔-蝶窦入路切除垂体大腺瘤13例

目的：了解鼻内镜技术用于经蝶窦入路切除垂体大腺瘤的可行性。方法：对13例垂体大腺瘤患者采用鼻内镜下经鼻腔-蝶窦入路切除术式。结果：肿瘤全切除9例(69．2％)，大部切除3例(23．1％)，手术失败1例(7．7％)。术后1周内视力、视野明显改善10例(76．9％)，其中7例接近或完全恢复正常。除2例短暂脑脊液漏外，无其他严重并发症及死亡病例发生。结论：鼻内镜用于经鼻腔-蝶窦入路切除垂体大腺瘤可获得满意的临床效果，但应注意避免术中出血、解剖变异、鞍旁组织向鞍内膨出、复发性垂体大腺瘤及术后不适当的瘤腔处理对鼻内镜手术操作及疗效的影响。     

单纯性蝶窦囊肿致脑脊液鼻漏一例

患者女，55岁。因反复头昏、头痛9年，加重伴左鼻“流水”5个月于2002年7月9日入院。患者9年前无明显诱因出现头昏、头痛，曾诊断为“高血压”，服降压药后症状缓解。5个月前出现左侧剧烈头痛、头昏、头胀伴恶心及非喷射性呕吐，并有左侧鼻腔清水样鼻漏。既往无外伤史。作头颅CT平扫正常，鼻流“清水”定性分析为脑脊液。诊断为：高血压伴自发性脑脊液鼻漏。     

应用鼻内镜治疗孤立性蝶窦病变(附9例报告)

随着鼻内镜技术发展 ,鼻内镜的治疗不仅仅局限于鼻腔疾病 ,而且延伸到颅底等领域。蝶窦的解剖部位深在 ,常规检查较难发现阳性体征 ,随着CT与MRI的临床应用 ,诊断水平已明显提高 ,本文报道应用鼻内镜治疗 9例蝶窦病变情况。1　资料与方法1 .1　临床资料近年来我科共诊治蝶窦病变 9例 ,其中右蝶窦囊肿 3例、左蝶窦囊肿 2例、右蝶窦霉菌病 2例、左蝶窦炎性息肉 2例 ,病史 1 0天至 6个月 ,均为头痛不适或痰中带血 ,经行CT扫描检查发现蝶窦病变 ,其中 1例提示蝶窦周边骨质破坏吸收。1 .2　手术方法本组 9例术前 30min均肌注阿托品 0 .5mg、安…     

经鼻内镜切除球后海绵状血管瘤一例

患者女, 32岁,以不明原因的左眼视力下降 10个月入院。患者一直按结膜炎、视神经萎缩等接受治疗,症状无改善,且视力下降明显,并伴有间隙性眼部隐痛。入院后检查:左眼球突出,左眼视力为 0 01,眼球活动正常,无复视,眼底检查黄斑区未见水肿,视乳头颞侧色略淡,乳头边界清,鼻内镜检查鼻腔未见明显异常。入院前 1个月行CT和MRI检查: CT示左眼球后眶间可见 2 0cm×1 6cm的类圆形软组织密度影,密度较均匀,增强扫描后异常密度影不均匀明显强化,相应左侧视神经受压后向内上移位,左侧内直肌及眼眶内壁亦轻度受压(图 1);MRI示左眼球后视神经旁…     

内镜下经鼻蝶入路治疗急性垂体卒中

目的　探讨内镜经鼻蝶入路治疗急性垂体卒中的手术技巧和围手术期的处理原则。方法　回顾性分析2000年1月～2013年12月51例经病理证实为急性垂体卒中的病例资料,均采用内镜下经鼻蝶入路手术,其中男28例,女23例,中位数年龄47岁,病程为4小时～7天。主要临床表现包括头痛、视觉功能障碍、垂体功能紊乱等。所有患者术前均行头部CT、MRI及内分泌学检查,围手术期补充肾上腺皮质激素,记录术后症状恢复情况及随访结果。结果  本组病例中肿瘤全切42例,次全切除9例,肿瘤全切率为82.35%,无严重并发症及死亡病例发生。术后随访1～14年,47例伴有头痛症状的患者术后头痛均消失或明显减轻;38例伴有视力下降的患者中,34例术后视力明显提高,术前已失明的4例患者中,3例术后恢复到眼前指动,1例术后视力无明显变化;伴发视野缺损及眼肌麻痹的患者,术后均恢复良好;28例伴有内分泌症状的患者中,22例术后症状明显缓解,症状改善不明显的6例术后复查MRI显示肿瘤有部分残留,予伽玛刀治疗,效果良好;所有患者随访至今未发现复发病例。结论　内镜经鼻蝶入路治疗急性垂体卒中是安全、有效的手术方法,完善的围手术期处理是保证手术成功的关键。     

鼻内镜下蝶窦开放术治疗真菌性蝶窦炎10例

目的观察鼻内镜下蝶窦开放术治疗真菌性蝶窦炎的疗效。方法回顾性分析鼻内镜下行蝶窦开放术治疗的10例真菌性蝶窦炎患者，总结其临床表现、影像学特征及治疗效果。结果真菌性蝶窦炎以涕中带血、头痛为主要症状表现，鼻窦CT扫描在其诊断中具有重要意义。经鼻内镜下蝶窦开放术治疗后随访1年，10例均未见复发。结论鼻内镜手术具有创伤小、出血少视野清晰、安全等优点，符合功能性手术的理念，是真菌性蝶窦炎的有效治疗方法。     

Calcified sphenoid mucocele

Sphenoid sinus mucoceles are uncommon lesions, and may rarely contain calcifications within their wall. We describe a new appearance of this lesion--sphenoid sinus mucocele with gross calcifications within its matrix.     

Anterior clinoid mucocele coexisting with sphenoid sinus mucocele

An anterior clinoid mucocele, known to be extremely rare, can lead to visual complications due to its proximity to the optic nerve. We report a patient who developed visual disturbance due to an anterior clinoid mucocele. Interestingly, the anterior clinoid mucocele coexisted with a sphenoid sinus mucocele. When an anterior clinoid mucocele coexists with a sphenoid sinus mucocele, more deliberate diagnostic and therapeutic approaches must be considered according to our first experience.     

A review of the endoscopic approach to the pituitary through the sphenoid sinus

PURPOSE OF REVIEW: The refinement of minimally invasive endoscopic techniques has resulted in 'pure' endoscopic endonasal trans-sphenoidal surgery, which is a new approach for the removal of pituitary tumors. RECENT DEVELOPMENTS: This procedure is performed via a wide anterior sphenoidotomy with detachment of the septum from the sphenoid face, and avoids the use of a trans-sphenoidal retractor and any intraoral or nasal incisions. Straight and angled endoscopes are used throughout the procedure to provide a wide view of the sella and are manipulated by a co-surgeon. This technique represents an improvement over pituitary microsurgery, with decreased post-operative morbidities and a shortened postoperative stay, and it eliminates the need for packing while providing an opportunity to monitor the sella after surgery. The technique has been established as being efficacious and safe. It incorporates image-guided surgery, with the fusion of computer tomography and magnetic resonance imaging, and employs new and dedicated instrumentation. Training in endoscopic techniques is required. SUMMARY: Future advancements in intraoperative imaging, cranial base reconstruction, and robotics will make this technique even more successful.     

Perioperative management of endoscopic transsphenoidal pituitary surgery

The contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery. Utility of a multi-disciplinary unit in management decisions facilitates the delivery of optimal care. Evolution of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these patients. The many areas of potential variability in the pre, intra and post-operative timeline of pituitary surgery are readily identifiable. Core undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.     

蝶窦囊肿术后感染致单眼失明一例

患者男，40岁。因左眼渐进性视力下降7年，加重伴头痛半年，以“蝶窭占位性病变”收住我院。入院前曾在院外因“左眼视神经萎缩．视网膜炎”多次给予抗生素、扩血管药、神经营养药物治疗，视力时好时坏。入院查体：体温36.4℃，血压135／85mmHg(1mmHg=0．133kPa)。左眼球轻度突出，视力：右眼1．0．左限0.6；左眼底检查：视盘色淡，动脉变细，动静脉比例超过1：2。     

Permanent central diabetes insipidus as a complication of sphenoid sinus mucocele

Although mucocele is a benign lesion, its unavoidable expansions may result in irreversible damages in adjacent organs. In spheno-ethmoid mucoceles which are extremely rare, this condition may cause more severe problems. Central diabetes insipidus, developed secondary to sphenoid sinus mucocele, was detected in a 54-year-old male patient, who underwent endoscopic sinus surgery 2 times due to nasal polyposis. Endoscopic sphenoid mucocele marsupialization was performed to the patient, but despite partial regression in the 1-year follow up, complete recovery was not observed.     

Ancient schwannoma of the nasal septum associated with sphenoid sinus mucocele

Schwannoma is a benign tumor arising from the sheath of myelinated nerve fibers and may occur in any part of the body. Ancient schwannoma, a variant of schwannomas, in the head and neck region is uncommon, and its occurrence in the nasal cavity and paranasal sinuses is extremely rare with only one case reported to date. Herein, we describe a rare case of sinonasal ancient schwannoma. The tumor arose from the nasal septum and extended to the sphenoid sinus. It was successfully treated by endoscopic sinus surgery, and the patient showed no evidence of recurrence 24 months postoperatively.