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目的:探讨蝶窦肿瘤病变并神经系统损害的临床特点和鼻内镜外科手术的要点。方法:回顾性分析13例蝶窦肿瘤病变并侵袭性神经系统损害患者的临床特征,鼻内镜术后随访神经系统症状的改善情况。结果:①侵袭性神经系统损害主要为脑神经受损,9例视神经、7例动眼神经、4例滑车神经、4例外展神经及1例三叉神经损害;其次为3例垂体功能减退,2例偏瘫失语。②鼻内镜治疗后神经系统症状改善。术后当日或次日,4例头痛及眼部症状减轻;术后3～7d,9例头痛和眼部症状明显减轻或消失;术后2周8例视力不同程度好转,9例头痛、1例复视、2例上睑下垂、1例眼球固定、2例面部疼痛、2例眶周麻木消失。随访期间无脑脊液漏、脑水肿、颅内出血等并发症出现。结论:蝶窦肿瘤病变侵袭性神经系统损害特点以脑神经受损为主要临床表现,其次为垂体功能受损。鼻内镜手术治疗可有效遏制蝶窦肿瘤病变的侵袭性神经系统损害。
Objective: To explore the clinical features of sphenoid sinus tumor lesions and nervous system damage and the main points of endoscopic surgery. Methods: The clinical features of 13 patients with sphenoid sinus neoplasm with invasive nervous system injury were retrospectively analyzed. The improvement of nervous system symptoms following endoscopic sinus surgery was retrospectively analyzed. Results: ① The main damage to the invasive nervous system was damage to the cranial nerves, 9 cases of optic nerve, 7 cases of oculomotor nerve, 4 cases of trochlear nerve, 4 cases of abducens nerve and 1 case of trigeminal nerve injury. The next was 3 cases of pituitary dysfunction, 2 Cases of hemiplegia aphasia. ② endoscopic treatment of nervous system symptoms improved. The headache and ocular symptoms were relieved in 4 cases on the day or the next day after operation. The headache and ocular symptoms were relieved or disappeared in 9 cases 3 to 7 days after operation. The visual acuity was improved in 8 cases Cases of diplopia, 2 cases of ptosis, 1 case of eye fixation, 2 cases of facial pain, 2 cases of periorbital numbness disappeared. During the follow-up no cerebrospinal fluid leakage, cerebral edema, intracranial hemorrhage and other complications appear. CONCLUSIONS: The characteristics of invasive nervous system damage in sphenoid sinus tumor are mainly the clinical manifestations of brain damage, followed by impaired pituitary function. Endoscopic surgery can effectively prevent the sphenoid sinus tumor lesions of the invasive nervous system damage.