Possibilities and limitations of endoscopic management of nasal and paranasal sinus malignancies.
Possibilities and limitations of endoscopic management of nasal and paranasal sinus malignancies.
复制标题
内窥镜治疗鼻和鼻旁窦恶性肿瘤的可能性和局限性。
DOI：
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发表时间：
1999
期刊：
影响因子：
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通讯作者：
G. Papaefthymiou
中科院分区：
文献类型：
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作者：
H. Stammberger;W. Anderhuber;C. Walch;G. Papaefthymiou
在过去的十年中，硬性内窥镜在鼻、鼻旁窦、鼻咽和前颅底肿瘤病变手术中的使用已经扩大和多样化。迄今为止，针对恶性病变的内窥镜手术方法的讨论仍然存在很大争议。从 1989 年到 1999 年，我们严格通过内窥镜、经鼻治疗了 43 名患有鼻旁窦和前颅底侵袭性/破坏性肿瘤的患者。其中包括 5 例幼年性血管纤维瘤患者和 36 例各种恶性肿瘤患者，其中 1 例患有垂体大型侵袭性大腺瘤，1 例患有颅咽管瘤。年龄范围为3个月至82岁。虽然最初的患者是出于姑息性目的而接受内窥镜治疗，但在过去几年中，我们已经开始对选定的恶性肿瘤进行内窥镜手术，以达到治愈目的。组织学上，接受手术的患者为各种癌分化的患者（n = 18），以及恶性黑色素瘤（n = 5）、感觉神经母细胞瘤（n = 8）、斜坡脊索瘤（n = 3）、未成熟畸胎瘤（n = 1）和平滑肌肉瘤（n = 1）的患者。我们的第一个结果似乎表明，该结果至少等于标准的外部方法，但具有出色的功能术语和显着更好的整体生活质量。当眼眶、硬脑膜/大脑和其他重要结构存在广泛浸润时，肿瘤的解剖学扩散造成了局限性。然而，对于经验丰富的人来说，该区域的内窥镜手术可能相当彻底，前颅底的骨头甚至硬脑膜都可以被切除，眶周也可以被切除，并且所有结构都可以在同一疗程中重建。内窥镜技术非常适合与神经外科等邻近专业合作。在个别情况下，伽玛刀疗法已被证明是一种非常有用的辅助疗法。通过这种联合方法，所有 8 名感觉神经母细胞瘤患者均存活并且没有疾病，平均观察时间为 37.2 个月。因此，我们将在未来的选定案例中继续使用此程序作为外部方法的可靠替代方案。然而，我们建议，这些技术仅适用于可以在需要时执行所有其他手术方法的中心。
Over the last decade, the use of rigid endoscopes in surgery of tumorous lesions of the nose, paranasal sinuses, nasopharynx and anterior skull base has extended and diversified. Endoscopic surgical approaches for malignant lesions are very controversially discussed as of today, yet. From 1989-1999 we have treated 43 patients with invasive/destructive tumors of the paranasal sinuses and the anterior skull base strictly endoscopically, transnasally. These included 5 patients with juvenile angiofibromas and 36 patients with various malignant tumors, one with a large invasive macroadenoma of the pituitary and one case of a craniopharyngeoma. The age range was 3 months to 82 years. Whereas the very first patients were approached endoscopically in a palliative intention, we have started endoscopic surgery for selected malignancies with curative intention in the last years. Histologically, patients with various carcinoma differentiation were operated (n = 18), as well as patients with malignant melanoma (n = 5), esthesioneuroblastoma (n = 8), clivus chordoma (n = 3), immature teratoma (n = 1) and leiomyosarcoma (n = 1). Our first results appear to indicate, that outcome is at least equal to standard external approaches, however with excellent functional terms and significantly better overall quality of life. The limitations result from the anatomical spread of the tumor, when extensive infiltration of orbit, dura/brain and other vital structures exist. However, in experienced hands, endoscopic surgery in this region can be rather radical, bone and even dura of the anterior skull base can be resected as can the periorbit, and all structures reconstructed in the same session. Endoscopic techniques lend themselves very well to cooperation with neighbouring specialities like neurosurgery. In individual cases, gamma-knife therapy has proven an extremely helpful adjunctive. With this combined approach, all 8 patients with esthesioneuroblastoma are alive and free of disease with a mean observation time of 37.2 months. We will therefore continue to use this procedure in selected cases as a reliable alternative to external approaches in the future. However we recommend, that these techniques are only applied at centers, where all other surgical approaches can be performed, should need for this arise.