目的:描述四种鼻内镜下鼻内途径,即,跨层纸莎草,经泪前隐窝,trans-Meckel\的洞穴,三叉神经鞘瘤(TSs)的经斜坡入路。
方法:这项回顾性研究回顾了2013年1月至2021年12月期间接受鼻内镜经入路(EEA)的38例TS患者的病历和术中录像。
结果:根据Jeong\的分类,对于中、后窝(MP)中的TS,在2例中进行了纯粹的跨梅克尔洞穴方法,并对4例患者进行了联合跨斜坡入路。涉及颞下窝的四个肿瘤(两个E3,一个mE3和一个Mpe3)通过经泪前隐窝入路进行,Mpe3型也得到了跨梅克尔洞穴方法的帮助。一名E1型患者接受了跨层纸莎草法治疗。其他27例,包括M型,Mp,ME2和MpE2都是通过纯粹的跨Meckel洞穴方法去除的。36例患者(97.4%)在纯粹的EEA下接受了全切除术。31例(88.6%)患者的功能能力和术前症状得到改善。8例(21.1%)患者出现永久性神经功能缺损。术后脑脊液及术中颈内动脉损伤1例(2.6%)。
结论:根据与不同TS位置相对应的特定内镜鼻内途径,对于大多数类型的肿瘤可以获得满意的结果。它代表了开放经颅方法的有效替代方法,也可以在具有经验丰富的手的大多数类型的TS中正确使用。
方法:4喉镜,2023年。
To describe four endoscopic endonasal subapproaches, namely, the trans-lamina papyracea, trans-prelacrimal recess, trans-Meckel\'s cave, and transclival approaches for trigeminal schwannomas (TSs).
This retrospective study reviewed the medical records and intraoperative videos of 38 patients with TSs who underwent endoscopic endonasal approach (EEA) between Jan 2013 and Dec 2021.
According to Jeong\'s classification, for TS equally in middle and posterior fossae (MP), a purely trans-Meckel\'s cave approach was carried out in 2 cases, and a combined transclival approach was carried out in 4 cases. The four tumors that involved infratemporal fossa (two E3, one mE3, and one Mpe3) were performed via a trans-prelacrimal recess approach, and type Mpe3 was also assisted by the trans-Meckel\'s cave approach. One patient with type E1 was treated with a trans-lamina papyracea approach. The other 27 cases, including type M, Mp, ME2, and MpE2, were all removed by a purely trans-Meckel\'s cave approach. Thirty-six patients (97.4%) received total resection under a purely EEA. The functional abilities and preoperative symptoms of 31 patients (88.6%) improved. Eight (21.1%) patients experienced permanent neurological function deficits. Postoperative cerebrospinal fluid and intraoperative internal carotid artery injury occurred in 1 (2.6%) patient.
According to the specific endoscopic endonasal subapproaches corresponding to the different TS locations, satisfactory results can be obtained for most types of tumors. It represents an effective alternative to the open transcranial approach and can also be properly used in most types of TS with experienced hands.
4 Laryngoscope, 133:2564-2571, 2023.