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Laryngoscope:新手术方法无痕移除脑瘤

作者:佚名 来源:梅思医学 日期:2017-01-08
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         Laryngoscope:新手术方法无痕移除脑瘤

关键字:  脑瘤 

        由约翰霍普金斯大学的外科医生开发出一种技术,这是一条新的方法去清除埋在颅底的肿瘤:通过后面的磨牙自然孔直达上方的颌骨,颧骨下方。

        在一份报告,详细介绍了一种新的手术,医生说的过程中,已经7例应用了此方法,产量恢复快,并发症少,相比于传统方法。而且,由于切口内的脸颊,有没有明显的疤痕。

        当一个20岁的女病人以前,医学博士,面部整形的助理教授和整形外科,耳鼻咽喉和约翰霍普金斯大学医学院头颈外科,科菲Boahene说,新方法的想法来到他开发一种新的肿瘤深在颅底脑肿瘤治疗。

        删除颅底肿瘤需要通过传统手术切口面部及骨去除,有时可能会导致毁容。此外,行动可能会损害面部神经,导致瘫痪,影响面部表情和天或周的住院治疗和恢复。 Boahene说,他凝视着在他的办公室的头骨模型,考虑到备用他从另一个传统手术的病人。 “我看着在颅骨已经存在的”窗口“,以上颌骨和颧骨下方,并意识到这是一个以前没有确认这种手术的通道,”他说。

        Boahene和他的同事们知道总是有选择切换到传统的做法,尝试新方法的同时,去年他的病人进行新的程序。预计的手术时间从6小时减少到两个。此外,病人可以离开医院,第二天返回到大学,没有明显证据,她做了手术进行。

        报告介绍了三个七Boahene和他的同事们迄今为止治疗的患者的手术细节。除了为病人的利益,他和他的同事指出,新的程序是显著复杂的外科医生执行,颅底区提供优秀的可视化,并可能保存保健美元,由于病人缩短住院时间。

        并非所有的病人都在此种方法的候选人,Boahene注意事项。首先它应该不是一个非常大的颅底肿瘤或肿瘤血管环绕的。他说,对于这些患者,传统的颅底外科手术仍是最好的选择。

        未来他和他的同事们打算尝试新的方法,比如使用外科手术的机器人,它可以为外科医生提供更好的可视化,并进一步降低患者出现并发症的机会。(生物谷Bioon.com)

        doi:10.1002/lary.22159

        PMC:

        PMID:

Endoscopic transvestibular paramandibular exploration of the infratemporal fossa and parapharyngeal space: A minimally invasive approach to the middle cranial base

        Jason Y. K. Chan MBBS, Ryan J. Li MD, Michael Lim MD, Alfredo Quinones Hinojosa MD, Kofi D. Boahene MD

        Objectives/Hypothesis:

        To describe a novel transvestibular endoscopic approach for the exposure, exploration, and resection of lesions in the infratemporal fossa (ITF) and parapharyngeal space (PPS).

        Study Design:

        Surgical technique and clinical feasibilty of a novel approach to the middle cranial base.

        Methods:

        The transvestibular endoscopic approach was applied to four patients with lesions involving the ITF and PPS. Through a vertical oral mucosal incision along the ascending ramus of the mandible, an optical corridor to the ITF and PPS was created and maintained with the aid of a Hardy speculum. The contents of the ITF and PPS were explored with the aid of a 0-degree 4-mm rigid endoscope.

        Results:

        Four patients underwent exploration of their right-sided ITF and PPS. The approach provided exposure and access from the middle cranial base at the level of the foramen ovale to the mid-PPS. Branches of the trigeminal nerve in the ITF were safely explored and preserved. Exposure and visualization of the internal maxillary artery and branches were achieved. Of the four patients, two underwent resection of a primary and a recurrent pleomorphic adenoma, one had chronic pain relief from a large synovial chondromatosis, and one had debulking of a recurrent mucoepidermoid carcinoma. The only complications were self-limiting hypoesthesia of the lip in one patient and transient dysphagia in another patient.

        Conclusions:

        The transvestibular endoscopic approach to the ITF and PPS offers direct and minimally invasive access to select lesions within this region. Further use of this approach will allow us to determine its potential and limitations.

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