经鼻内镜蝶窦进路岩尖胆脂瘤切除

目的 探讨经鼻内镜蝶窦进路岩尖部胆脂瘤囊内切除术的可行性及疗效.方法 回顾性分析2001-2006年经鼻内镜蝶窦进路切除鞍旁、岩尖部胆脂瘤患者3例的临床资料.3例患者均在全麻下经鼻内镜全筛窦、蝶窦开放,于蝶窦外侧壁、颈内动脉前方磨开颅底骨板进入岩尖部,切开并扩大胆脂瘤囊壁后,采用吸引、刮除和冲洗的方法将胆脂瘤进行囊内清除.结果 3例岩尖胆脂瘤经囊内切除手术,均一次清除干净,手术前伴有头痛和眶尖综合征的2例患者于术后当天即有症状改善,术后1～4周症状完全恢复,全部患者未发生手术并发症.术后随访3～7年,全部患者症状未再发,影像学检查胆脂瘤无复发.结论 靠近鞍旁区域的岩尖胆脂瘤可以采用经鼻内镜蝶窦进路行囊内切除手术,远期疗效可靠.

Resection of petrous apex cholesteatoma via endoscopic trans-sphenoidal approach

Objective To introduce our experience of resection of petrous apex cholesteatoma through endoscopic,transnasal,trans-sphenoidal approach in 3 cases,and present a surgical technique of intracystic resection of lesion which yielded a relatively stable long-term outcome.Methods Resection of parasellar and petrous apex cholesteatoma via endoscopic transsphenoidal approach was performed in three patients between 2001 and 2006.Surgical technique was as follows: the ethmoid and sphenoid sinuses were opened under endoscope,the petrous apex was accessed by drilling skull base bone at the lateral wall of sphenoid sinus and anterior to the internal carotid artery,the cyst wall of cholesteatoma was incised and expanded,then intracystic removal of cholesteatoma was achieved by the suction,curette and rinsing.Results The petrous apex cholesteatoma in all 3 patients were removed clearly by endoscopic,transnasal,trans-sphenoidal surgery in one time.Before surgery,two patients with headache and orbital apex syndrome had a remarkable improvement just on the day after operation and completely recovered in 1-4 weeks.No postoperative complications happened in all three patients.All patients had no recurrence in symptoms and no imaging evidences of recurrence at a follow-up of 3-7 years. Conclusion The petrous apex cholesteatoma around the parasellar region could be treated by intracystic removal via endoscopic,transnasal,transsphenoidal approach,without the need to strip and remove the cyst wall,and the long-term efficacy was reliable.