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目的探讨影像导航系统在经鼻内镜切除前颅底骨化纤维瘤手术中的作用。方法选择影像导航引导下经鼻内镜手术切除累积眶纸板、颅底骨质的筛窦骨化纤维瘤12例男性患者,初次手术9例,复发病例3例。术前行鼻窦CT连续扫描,骨算法,层厚1mm。结果CT显示所有病例筛骨水平板、眶纸板受累。4例前界至额隐窝前缘(鼻骨后);6例累及眶尖与蝶窦外侧壁交界处;1例广泛累及上颌骨、蝶骨大翼、蝶鞍和斜坡。11例彻底切除病灶,1例(病变广泛者)切除大部分肿瘤。平均手术时间3.2小时,影像导航配准过程平均25分钟。1例术中并发脑脊液漏,术中鼻内镜下修补成功;3例术中损伤眶纸板,无手术及术后并发症。术后随访5个月～4年,姑息手术病例肿瘤生长缓慢,其余病例无复发,症状明显改善。结论借助影像导航引导,经鼻内镜手术切除累及眶纸板、前颅底骨质的骨化纤维瘤,具有一定优势,但病灶不应广泛侵及额隐窝、蝶骨及斜坡。
Objective To explore the role of video navigation system in transnasal endoscopic resection of skull base ossifying fibroma. Methods 12 cases of male patients with orbital bone and fibrous calcified skull base sutured by endoscopic endoscopic sinus surgery under nasal endoscope were included in this study. Nine cases were initially operated and three cases were recurred. Preoperative sinus CT continuous scan, bone algorithm, layer thickness 1mm. Results CT showed all cases of ethmoid bone plate, orbital cardboard involvement. Four cases had anterior border to the front of the crypt (posterior nasal bone), six cases involved the junction of the orbital apex and the lateral sphenoid sinus, and one involving the maxilla, sphenoid wing, sella and slope. Thirteen patients underwent complete resection of the lesion and one patient (extensive lesion) underwent resection of most of the tumors. The average operation time was 3.2 hours, and the imaging navigation registration process averaged 25 minutes. One case was complicated with cerebrospinal fluid leakage during operation, and the operation was successfully completed by endoscopic sinus surgery. In 3 cases, the orbital cardboard was damaged during operation, with no complications of surgery and postoperative complications. The patients were followed up for 5 months to 4 years. The tumor growth was slow in palliative surgery patients and no recurrence was observed in other cases. The symptoms were significantly improved. Conclusion Nasal endoscopic surgical removal of orbital cardboard, anterior skull base ossifying fibroids with video navigation guidance, has some advantages, but the lesions should not be extensive invasion of the frontal recess, sphenoid bone and slope.