The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, petrous apex, and the Meckel cave

被引:128
|
作者
Hofstetter, Christoph P. [1 ]
Singh, Ameet [2 ]
Anand, Vijay K. [2 ]
Kacker, Ashutosh [2 ]
Schwartz, Theodore H. [1 ,2 ,3 ]
机构
[1] New York Presbyterian Hosp, Weill Cornell Med Coll, Dept Neurol Surg, New York, NY 10021 USA
[2] New York Presbyterian Hosp, Weill Cornell Med Coll, Dept Otolaryngol, New York, NY 10021 USA
[3] New York Presbyterian Hosp, Weill Cornell Med Coll, Dept Neurol & Neurosci, New York, NY 10021 USA
关键词
endoscopy; minimally invasive approach; petrous apex; pterygopalatine fossa; skull base; encephalocele; transpterygoid approach; infratemporal fossa; LATERAL SPHENOID SINUS; TRANSNASAL APPROACH; SURGERY; RECESS; RHINORRHEA; RESECTION;
D O I
10.3171/2009.10.JNS09157
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. In this paper the authors' goal was to present their clinical experience with lesions of the pterygopalatine fossa, infratemporal fossa, lateral sphenoid sinus, cavernous sinus, petrous apex, and Meckel cave using simple and extended endoscopic transpterygoid approaches to the lateral skull base. Methods. Simple and expanded endoscopic transpterygoid approaches were performed in a series of 13 patients with varying pathology that included lateral sphenoid sinus encephaloceles, benign and malignant sinonasal tumors, and lesions of neural origin. Results. A gross-total resection was achieved in 5 of 9 patients, while a subtotal resection for tissue diagnosis and cytoreduction prior to further adjuvant treatment was performed in the remaining patients. Sphenoid sinus encephaloceles were successfully repaired via a transpterygoid approach in all 4 patients. The skull base defect was reconstructed using a multilayered closure. One patient developed a postoperative CSF leak, which was successfully treated conservatively. The mean follow-up time was 16 months. Five patients complained of recurrent sinusitis. One patient experienced xerophthalmia and palate numbness. Three patients had died by the time of this report. Two patients died of unrelated causes. The third patient died of progression of an aggressive pterygopalatine osteosarcoma despite undergoing cytoreductive surgery and adjuvant chemotherapy. Conclusions. An endoscopic transpterygoid approach is a minimally invasive endoscopic approach for lesions located or extending to the pterygopalatine fossa, infratemporal fossa, petrous apex, Meckel cave, and other regions of the paramedian skull base. (DOI: 10.3171/2009.10.JNS09157)
引用
收藏
页码:967 / 974
页数:8
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