Abstract:A young girl who sought medical attention for "right cavernous sinus-sellar chondroma in 9 months after surgery and unclear vision in her right eye for 1 month" had progressive visual acuity decline, and was found to have a right cavernous sinus tumor after examination**. Due to the complexity and difficulty of the operation, the local hospital recommended that you go to Beijing for medical treatmentAfter the patient is contacted online, he or she comes to our hospital for medical treatment. I surgically removed the patient's cavernous sinus tumor, relieved the right optic nerve compression, and the patient's vision improved.
1. Comparison before and after surgery
On admission, the patient appears to be in good condition and has decreased vision on his right side on examination. Preoperative MRI of the brain: right orbital apex-cavernous sinus-posterior bed process tumor, irregular morphology and unclear borders. MRA: Significant compression displacement of the right internal carotid cavernous sinus segment-posterior communication segment. After completing the relevant examinations, I performed ultrasound-assisted translateral fissure-right orbital apex-cavernous sinus-posterior bed process** chondroma resection + dural repair + bone flap reduction and fixation for the patient under general anesthesia, and the operation went smoothly. After the operation, the right optic nerve was fully decompressed, the visual acuity was improved, and the ocular motor nerve and trigeminal nerve were well protected. Follow-up CT of the brain showed that the tumor was completely resected and no abnormalities were found.
2. Preoperative diagnosis
The patient has a clear history of previous surgery for cavernous sinus-sellar chondroma and decreased vision on the right side. MRI of the brain: right orbital apex-cavernous sinus-posterior bed process tumor, irregular morphology and ill-defined borders. MRA: Significant compression displacement of the right internal carotid cavernous sinus segment-posterior communication segment. Based on the medical history and clinical symptoms, combined with the results of MRI of the brain, the diagnosis was made of right orbital apex-cavernous sinus-posterior bed process** chondroma. After admission, routine preoperative examinations such as blood routine, biochemistry, coagulation, and electrocardiogram were improved, and no obvious abnormalities were found, and contraindications to surgery were ruled out. The patient had obvious tumor occupancy, severe neurological impairment, and sufficient indication for surgery, so it was recommended that the patient undergo aggressive surgery to relieve optic nerve compression.
Third, the design scheme
The patient had orbital apical-cavernous sinus-posterior bed process tumor, which is closely related to the internal carotid artery and has a high surgical riskThe internal carotid artery and its branches, the optic nerve, and the peripheral cranial nerves of the cavernous sinus need to be effectively protected during surgery. We used a pterygoid point approach to fully expose the right orbital apex-cavernous sinus-posterior bed process area and fully dissect the cavernous sinusThe anterior bed process was grinded, the optic nerve canal was opened, the posterior bed process was ground out, and the posterior pole tumor was fully dissectedIntraoperative vascular ultrasound assists in protecting the internal carotid artery.
Fourth, the first effect
Before the operation, the patient and family were fully explained to the patient and family about the necessity of the surgery and the risks associated with the surgery, and the consent and cooperation of the patient and family were obtained. After fully improving the preoperative preparations, ultrasound-assisted translateral fissure-right orbital apex-cavernous sinus-posterior bed process** chondroma resection + dural repair + bone flap reduction and fixation was performed under general anesthesia, and the operation was smooth and time-consuming5 hours. The patient is awake and returns to the ward. Brain CT was re-examined 4 hours after surgery: the tumor was completely resected and no abnormalities were found.
The patient recovered well after surgery and had a normal body temperature. Liquid eating was resumed on the 2nd day after surgery, and he got out of bed on the 3rd day. The right side of the vision gradually improved after surgery.
FiveReview summary
Postoperative pathological results suggested: chondroma. The pathological results of the patient were benign, the tumor was resected satisfactorily, and no assistance was performed**. Outpatient follow-up for 6 months, no tumor**.
6. Postoperative precautions
1. Do a good job of surgical incision management after surgery to reduce the risk of intracranial infection.
2. Pay attention to keeping warm, avoid coughing and sneezing, keep the stool smooth, and promote the healing of the skull base.
3. After discharge, if you have fever, headache, nausea, vomiting and other uncomfortable symptoms, seek medical treatment in time.
After a month, the outpatient clinic will be followed up by MRI of the head.