Frontal Sinus "Hump": An Anatomical Risk Factor for Anterior Skull Base Injury in the Endoscopic Modified Lothrop Approach (Outside-In Frontal Drill-Out).

IF 0.4 Q4 OTORHINOLARYNGOLOGY Case Reports in Otolaryngology Pub Date : 2021-07-22 eCollection Date: 2021-01-01 DOI:10.1155/2021/3402496
Teppei Takeda, Kazuhiro Omura, Haw Torng, Teru Ebihara, Satoshi Aoki, Kosuke Tochigi, Hiromi Kojima, Nobuyoshi Otori
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Abstract

Skull base injuries caused by the outside-in frontal drill-out technique have not been reported. In this report, we chose an outside-in approach to open the frontal sinus for olfactory neuroblastoma resection. Although we identified the first olfactory fibre, the anterior skull base was damaged while drilling into the frontal sinus on the tumour side. We reconstructed the skull base in multiple layers using fascia and cartilage. Postoperative cerebrospinal fluid leakage or intracranial haemorrhage was not observed. In this case, a morphological difference existed in the posterior wall of the frontal sinus between the right and left sides, like a "hump" in the posterior wall of the frontal sinus. This case of damage to the anterior skull base that could not be avoided by identifying the first olfactory fibre alone is the first published case of skull base injury caused by the outside-in approach due to morphological variations of the frontal sinus and skull base. In this approach, the posterior wall of the frontal sinus cannot be observed because the intraoperative landmark is limited to the first olfactory fibre. Therefore, morphological variations of the posterior wall of the frontal sinus should be analysed in advance to prevent cranial base injury.

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额窦“驼峰”:内镜下改良Lothrop入路(由外向内额部钻出)前颅底损伤的解剖学危险因素。
由外向内额部钻孔技术造成颅底损伤尚未见报道。在本报告中,我们选择了一种由外而内的方法来打开额窦进行嗅神经母细胞瘤切除术。虽然我们发现了第一嗅纤维,但在肿瘤一侧的额窦钻孔时,前颅底受损。我们利用筋膜和软骨重建了多层颅底。术后未见脑脊液漏或颅内出血。在本例中,左右两侧额窦后壁存在形态差异,如额窦后壁出现“驼峰”。本例前颅底损伤不能通过单独识别第一嗅纤维来避免,这是第一例因额窦和颅底形态变化而由外向内入路引起颅底损伤的病例。在这种入路中,由于术中标记仅限于第一嗅纤维,因此无法观察到额窦后壁。因此,应提前分析额窦后壁的形态学变化,防止颅底损伤。
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来源期刊
Case Reports in Otolaryngology
Case Reports in Otolaryngology OTORHINOLARYNGOLOGY-
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发文量
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审稿时长
13 weeks
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