Endoscopic Endonasal Transpterygoid Approaches
试验速览
- 阶段
- 不适用
- 入组人数
- 25
- 主要终点
- Type of the pathology
研究概览
简要总结
To identify:
- The most frequent pathologies affecting pterygopalatine fossa, lateral recess of the sphenoid sinus, petrous apex, Meckel's cave, cavernous sinus, infratemporal fossa and lateral nasopharynx that can be treated by endonasal endoscopic transptergoid approaches, the most common presenting manifestations and indication of surgery.
- The different techniques and feasibility of different endonasal endoscopic transpterygoid approaches and the frequency of utilization of approach.
- Try to establish a protocol for post-operative care and management of complications.
- Obtain sufficient surgical experience in endonasal endoscopic transpterygoid surgery to establish endonasal endoscopic skull-base surgery in Assiut University Hospital.
详细描述
Skull base surgery has undergone dramatic advances. During early stages, the endoscopic approaches were limited by the resultant skull base defects .
Access to the pterygopalatine fossa (PPF) is a surgical challenge due to its deep location in the mid-third of the face and its complex array of vascular and neural structures. An important aspect of the PPF is its topographical relation to the orbit and cranial cavity.
The philosophy behind the transpterygoid approach centers on the maxillary sinus as the primary corridor, displaces the contents of the PPF and removes the pterygoid process partially or completely to reach to the lateral extent of the endonasal technique.
The endoscopic endonasal transpterygoid approaches classified into five types. Type A involves thinning of the pterygoid process to gain access to PPF. Type B involves removal of the medial and anterior aspect of the base of the pterygoid process to access the lateral recess of the sphenoid sinus. Type C involves dissecting the vidian nerve to identify the petrous ICA and removing the base of the pterygoid plates to reach the petrous apex, Meckel's cave, or cavernous sinus. Type D requires a variable removal of the pterygoid plates to access the infratemporal fossa. Type E requires removal of part or even the entire pterygoid process, and the medial third of the Eustachian tube to provide exposure of the lateral nasopharynx.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Any patient with lesions affecting pterygopalatine fossa, lateral recess of the sphenoid sinus, petrous apex, Meckel's cave, cavernous sinus, infratemporal fossa and lateral nasopharynx that can be treated by endonasal endoscopic transptergoid approaches.
排除标准
- •Medically unfit patients for surgery
- •In case of distant metastasis in tumors
研究组 & 干预措施
patients
The patient who have lesions affecting pterygopalatine fossa, lateral recess of the sphenoid sinus, petrous apex, Meckel's cave, cavernous sinus, infratemporal fossa and lateral nasopharynx and can be treated by endonasal endoscopic transptergoid approaches
干预措施: Transpterygoid approaches (Procedure)
结局指标
主要结局
Type of the pathology
时间窗: 1 week
Identification of the type lesion will be made.
Frequency of residual mass
时间窗: 1 week
Early MRI will be obtained after a week to asses the extent of resection and search if there is residual mass.
Frequency of recurrence
时间窗: 6 months
Imaging will be done in six months period to search for any recurrence.
Frequency of complication
时间窗: 1 month
Post-operative follow up of the patients will be done to identify the frequency of complication either rhinogenic as bleeding , synechiae, csf leakage or orbital complication as proptosis, visual affection or intracranial complication as meningitis.
Operation time
时间窗: intraoperative
The time of the operation will be calculated in this endoscopic approach comparing to traditional open technique.
Intraoperative bleeding
时间窗: Intraoperative
The amount of intraoperative bleeding and the ability to control it.
Surgical field exposure
时间窗: Intraoperative
The possibility of the approach to reach lesions affecting deep area in the skull as pterygopalatine fossa, lateral recess of the sphenoid sinus, petrous apex, Meckel's cave, cavernous sinus, infratemporal fossa and lateral nasopharynx.
Post-operative stay
时间窗: 2 weeks
post-operative stay of the patient in hospital.
mortality rate
时间窗: 1 year
any deaths
次要结局
未报告次要终点
研究者
Ahmed El-Rahman Mohamed Azzam
Dr.Ahmed EL-rahman Mohamed Azzam, Assistant lecture of otorhinolaryngology department
Assiut University