Challenges in the Management of Sphenoid Inverted Papilloma
Challenges in the Management of Sphenoid Inverted Papilloma
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DOI：
10.1177/194589240501900216
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发表时间：
2005-03
影响因子：
2.6
通讯作者：
Samer Fakhri;M. Citardi;Stephen G. Wolfe;P. Batra;R. Prayson;D. Lanza
中科院分区：
文献类型：
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作者：
Samer Fakhri;M. Citardi;Stephen G. Wolfe;P. Batra;R. Prayson;D. Lanza
摘要蝶窦内翻性乳头状瘤是一种非常罕见的疾病。蝶窦IP的治疗尤其具有挑战性，因为其临床表现上缺乏鼻窦症状，并且与蝶窦的解剖位置相关的固有手术风险。方法回顾性分析所有蝶窦内IP患者的临床资料。结果共发现5例患者。所有患者均行内镜下切除。最常见的症状是头痛（3例患者）。平均随访时间为37.6个月（范围：10-79个月）。2例邻近颈内动脉的侵蚀性颅底病变患者采用分期内镜切除术进行治疗。只有1名患者在38个月后复发，并接受了翻修内镜切除术。结论内窥镜下治疗蝶骨IP可以最大限度地切除，并发症最少，并有利于内窥镜术后监测。完整的术前放射学评估肿瘤的范围是必不可少的。术前药物治疗可以帮助炎症粘膜恢复正常，减少术中出血。对于较大的糜烂性IP，可以通过考虑分期切除和使用计算机辅助手术来最大限度地降低手术风险。
Background Inverted papilloma (IP) arising in the sphenoid sinus is extremely rare. Management of sphenoid sinus IP is especially challenging because of the paucity of sinonasal symptoms on presentation and the inherent surgical risks associated with the anatomic location of the sphenoid sinus. Methods We performed a retrospective review of medical records of all patients with IP arising within the sphenoid sinus. Results A total of five patients were identified. All patients were managed with endoscopic resection. The most common presenting symptom was headache (three patients). The mean follow-up period was 37.6 months (range, 10–79 months). Two patients with erosive skull base lesions adjacent to the internal carotid artery were managed with a staged endoscopic resection. Only one patient developed a recurrence after 38 months and underwent revision endoscopic resection. Conclusions Endoscopic management of sphenoid IP allows maximal resection with minimal morbidity and facilitates endoscopic postoperative surveillance. Complete preoperative radiological assessment of tumor extent is essential. Preoperative medical therapy can help normalize inflamed mucosa and minimize intraoperative bleeding. For large erosive IP, surgical risks may be minimized by considering a staged resection and using computer-aided surgery.