Zones of approach for cranicifacial resection: Minimizing facial incisions for resection of anterior cranial base and paranasal sinus tumors
Zones of approach for cranicifacial resection: Minimizing facial incisions for resection of anterior cranial base and paranasal sinus tumors
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DOI：
10.1227/01.neu.0000088802.58956.5a
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发表时间：
2003-11-01
期刊：
影响因子：
4.8
通讯作者：
Couldwell, WT
中科院分区：
文献类型：
--
作者：
Liu, JK;Decker, D;Couldwell, WT
目的：前颅底肿瘤的手术切除与颅面联合的方法，经常涉及毁容面部切口和面部截骨术。作者概述了三个手术区的前颅底和副鼻窦中，肿瘤可以切除三个标准的手术方法，最大限度地减少transfacial切口和广泛的面部osteotomies.METHODS：该地区进行解剖10具尸体的头部和评价放射影像的前颅底肿瘤患者的定义。在每具尸体上进行的三种方法是transbasal，trans上颌，并扩大transsphenoidal.Results：三个区域的方法被定义为访问前颅底，鼻腔，鼻窦肿瘤。1区通过经基底入路暴露，其前部由眶上缘限定，后部由视交叉和斜坡限定，前部由腭限定，外侧由内侧眶壁限定。该入路可进入整个前颅底、鼻腔和大部分上颌窦。眼眶的限制导致上颌窦上外侧范围内存在盲点。2区通过唇下上颌骨切开术入路暴露，进入整个上颌窦，包括上外侧盲点和同侧前海绵窦。然而，进入前颅底是有限的。经蝶入路暴露3区。该入路可进入中线结构，但受限于鼻侧壁和海绵窦内颈动脉。扩大的经蝶入路可进一步暴露前颅底、斜坡或海绵窦。内窥镜的使用有利于肿瘤切除术在鼻腔和鼻窦sinuses.CONCLUSION：手术区概述提供微创颅面途径访问病变的前颅底和鼻窦，避免面部切口和面部截骨术。案例说明展示的方法选择范例。
OBJECTIVE: Anterior cranial base tumors are surgically resected with combined craniofacial approaches that frequently involve disfiguring facial incisions and facial osteotomies. The authors outline three operative zones of the anterior cranial base and paranasal sinuses in which tumors can be resected with three standard surgical approaches that minimize transfacial incisions and extensive facial osteotomies.METHODS: The zones were defined by performing dissections on 10 cadaveric heads and by evaluating radiographic images of patients with anterior cranial base tumors. The three approaches performed on each cadaver were transbasal, transmaxillary, and extended transsphenoidal.RESULTS: Three zones of approach were defined for accessing tumors of the anterior cranial base, nasal cavity, and paranasal sinuses. Zone 1 is exposed by the transbasal approach, which is limited anteriorly by the supraorbital rim, posteriorly by the optic chiasm and clivus, inferiorly by the palate, and laterally by the medial orbital walls. This approach allows access to the entire anterior cranial base, nasal cavity, and the majority of maxillary sinuses. The limitation imposed by the orbits results in a blind spot in the superolateral extent of the maxillary sinus. Zone 2 is exposed by a sublabial maxillotomy approach and accesses the entire maxillary sinus, including the superolateral blind spot and the ipsilateral anterior cavernous sinus. However, access to the anterior cranial base is limited. Zone 3 is exposed by the transsphenoidal approach. This approach accesses the midline structures but is limited by the lateral nasal walls and intracavernous carotid arteries. An extended transsphenoidal approach allows further exposure to the anterior cranial base, clivus, or cavernous sinuses. The use of the endoscope facilitates tumor resection in the nasal cavity and paranasal sinuses.CONCLUSION: The operative zones outlined offer minimally invasive craniofacial approaches to accessing lesions of the anterior cranial base and paranasal sinuses, obviating facial incisions and facial osteotomies. Case illustrations demonstrating the approach selection paradigm are presented.