■当颞叶通过蝶骨大翼的缺损突出到蝶骨空气窦时,就会发生颞叶蝶骨脑炎。自然史没有被很好地理解,尽管在成年后出现脑脊液鼻漏和/或脑膜炎是典型的。蝶窦的侧向气化和BMI升高可能是原因。
■我们探索了经眶入路(TOA)修复的可行性,使用三维建模和仿真的结合。然后,我们成功地在体内部署了这项技术。
■使用CT成像对三名先前接受过经颅颞叶蝶骨侧脑室修复的患者进行了成像,以生成数据,从而可以生成3D打印的颅底模型。通过进行外侧眼眶切开术,然后钻孔蝶骨翼以暴露前基底中窝来模拟经眶入路。3D对象扫描用于创建颅底手术后的虚拟模型,通过两种方式对手术入路进行量化:TOA暴露的中窝面积(mm2)和垂直迎角。
■通过模拟TOA实现的颅骨进入窗口的平均表面积为325mm2。平均垂直迎角为25°。一名患者随后通过TOA成功治疗,其CSF泄漏没有复发。无眼眶发病,优秀的宇宙,但解决V2麻木(随访7个月)。
■我们已经证明经眶入路可提供足够的手术入路。在我们的单一案例中,通过TOA手术修复颞叶蝶窦侧脑瘤是可行的,安全,而且有效。与经颅或经鼻入路相比,这种方法可能具有一些优势。
UNASSIGNED: A temporo-sphenoidal encephalocoele occurs when temporal lobe herniates through a defect in the greater wing of the
sphenoid bone into the
sphenoid air sinus. The natural history is not well-understood, though presentation in adulthood with CSF rhinorrhoea and/or meningitis is typical. Lateral pneumatisation of the
sphenoid sinus and elevated BMI may be contributory.
UNASSIGNED: We explored the feasibility of a transorbital approach (TOA) for repair, using a combination of 3D modelling and simulation. We then successfully deployed this technique in vivo.
UNASSIGNED: CT imaging for three patients who had previously undergone transcranial repair of lateral temporo-sphenoidal encephalocoele was used to generate data allowing 3D printed models of the skull base to be produced. The transorbital approach was simulated by performing a lateral orbitotomy followed by drilling of the
sphenoid wing to expose the antero-basal middle fossa. 3D object scanning was used to create virtual models of the skull base post-surgery, from which surgical access was quantified in two ways: the area (mm2) of the middle fossa exposed by the TOA and the vertical attack angle.
UNASSIGNED: The mean surface area of the cranial access window achieved by simulated TOA was 325mm2. The mean vertical attack angle was 25°. One patient was subsequently treated successfully via TOA with no recurrence of their CSF leak, no orbital morbidity, excellent cosmesis, but resolving V2 numbness (follow-up 7 months).
UNASSIGNED: We have shown that the transorbital approach provides adequate surgical access. In our single case, surgical repair of a lateral temporo-sphenoidal encephalocoele via TOA was feasible, safe, and effective. This approach may offer some advantages compared with transcranial or endonasal approaches.