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Endoscopic transsphenoidal surgery using pedicle vascularized nasoseptal flap for cholesterol granuloma in petrous apex : A technical note


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タイトル: Endoscopic transsphenoidal surgery using pedicle vascularized nasoseptal flap for cholesterol granuloma in petrous apex : A technical note
著者: Ishi, Yukitomo 著作を一覧する
Kobayashi, Hiroyuki 著作を一覧する
Motegi, Hiroaki 著作を一覧する
Endo, Shogo 著作を一覧する
Yamaguchi, Shigeru 著作を一覧する
Terasaka, Shunsuke 著作を一覧する
Houkin, Kiyohiro 著作を一覧する
キーワード: cholesterol granuloma
petrous apex
transsphenoidal surgery
nasoseptal flap
発行日: 2016年11月
出版者: Elsevier
誌名: Neurologia i neurochirurgia polska
巻: 50
号: 6
開始ページ: 504
終了ページ: 510
出版社 DOI: 10.1016/j.pjnns.2016.08.006
抄録: Background: Compared with surgical resection, endoscopic transsphenoidal surgery (TSS) for cholesterol granuloma (CG) in the petrous apex (PA) is associated with local recurrence due to obstruction of the drainage route. We present a detailed procedure of an endoscopic TSS using pedicle vascularized nasoseptal flap (PVNF). Methods: A 40-year-old woman with a history of repeated surgery for left tympanitis was referred to our institution. Neurological examination revealed severe hearing loss in the left ear. Radiologic examination presented a round mass in the left PA and significant fluid collection in the mastoid air cells of the left temporal bone. CG was strongly suspected, and endoscopic TSS using PVNF was performed. Prior to endoscopic drainage, a PVNF was harvested from the mucosa of the ipsilateral nasal septum, with an attempt to preserve the sphenopalatine artery in the flap. Following this, puncture and adequate irrigation of the lesion was performed by endoscopic TSS, with neuro-navigation system assistance; the apex of PVNF was then placed into the lesion to prevent the obstruction of the drainage route. An absorbable polyglycolic acid sheet and fibrin glue were applied on the flap to prevent spontaneous deviation from the lesion. Results: The patient was discharged without any further neurological complications. Eight month postoperative computed tomography images showed no recurrence; the drainage route was patent and the fluid collection in the left mastoid air cells was resolved. Moreover, hearing loss was improved. Conclusions: Endoscopic TSS using PVNF may be one of available surgical options for PACG.
Rights: © 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license
資料タイプ: article (author version)
出現コレクション:雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

提供者: 伊師 雪友


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