Transpalatal-transpharyngeal Approach For The Treatment Of Tumors In The Midline Area Of Skull Base: Microsurgical Anatomy And Clinical Application

Part one The microsurgical anatomy research of Transpalatal-transpharyngeal approach for the treatment of tumors in the midline area of skull baseObjective To explore the microsurgical anatomy of the transpalatal-transpharyngeal approach and provide an advisable anatomic reference for protection of vital structures.Methods 20 dry skulls were used to observe and measure the osseous structures.15 cadaveric heads of Chinese adults fixed by 10%formalin, age and sex couldn't be exactly judged.In order to maintain the caliber of blood vessels normally and improve the quality of photos,red latex was injected into arterial systems.Transpalatal-transpharyngeal approach were mimicked on the cadaveric heads and photos of the microanatomic structures related to the approach were took.All datas were statistically processed and presented in the means(range of measured values)style.Results Inverse "U"-shape petal was suitable in the transpalatal- transpharyngeal approach.Operative incision should be near to medial surface of alveolarprocess as far as possible.Abrading posterior wall of sinusethmoidalis and sphenoid platform,stripping partial sclerotin of tuberculum sellae,posterior wall of sphenoidalsinus,dorsum sellae,slope andthe anterior arch of atlas,and then structures including chiasmatic cistern,optic nerve,pituitary gland and brain stem were exposed by microtubule discission of dura.Conclusion Transpalatal-transpharyngeal approach has good exposure and the microsurgical anatomy of this approach has an important significance for resection of tumors in the midline area of skull base. Part two The clinical research of Transpalatal-transpharyngeal approach for the treatment of tumors in the midline area of skull baseObjective To explore the microsurgical methods for treatmenting of tumors in the midline area of skull base.Methods The clinical data of 18 consecutive patients with tumors in midline of skull base operated upon through transpalatal-transpharyngeal approach were retrospectively reviewed.Intra-operation whole piece of hard palatine was liberated,and tumor was removed by several pieces under microscope.After completion of the operation,hard palatine was repaired,and sclerotin of hard palatine was repositioned and fixed.Results Of the 18 patients,9 patients suffered from chordoma,3 from metastases,2 from angiofibroma,2 from pituitary adenoma,1 from carcinoma of nasopharynx,1 from posterior pharyngeal squamous epithelial carcinoma.The operation field of all 18 patients was satisfactorily exposed.The tumors of 12 cases were totally removed under microscope,and 6 tumors were subtotally removed.The complications included rhinorrhea in 1 case and hypernasal in 1 case. There was no operative mortality and hemiplegia.All patients were followed up for 6～30 months with MRI.Two of them had local recurrence within 1 year,1.5 years,2 year after operation respectively. 1 metastasis died from the primary focus in lung.The remainders had resumed their normal life.Conclusion Transpalatal-transpharyngeal approach for the treatment of tumors in the midline area of skull base was an ideal approach,with satisfying exposur,alleviative operative trauma and fewer complications.