颅底癌
Kurtis White
Toward the end of 2010 and well into 2011, 32-year-old Kurtis White had a persistent runny nose that he assumed was caused by allergies. After trying various over-the-counter medications for nearly six months—without relief—he made an appointment with his primary care physician. When the doctor found what looked a polyp and suggested he see an ENT, White made an appointment with an otolaryngologist who practices in White’s hometown of Austin, Texas.
“When I saw him, he said ‘You have something blocking your nose and it doesn’t appear to be a polyp. Let’s get you into surgery and find out what it is,’” White says. “I woke up feeling fine but when I saw him after the surgery, he told me he suspected it was a tumor. Instead of removing it, he did a biopsy.”
几天后，怀特在办公室访问中获悉，他的第一次邮政访问中的第一次访问中，他患有Esthisioneuroblastoma，这是上鼻腔上腔腔的罕见恶性肿瘤和前颅底。“博士卡恩（Kahn）告诉我，这是他没有太多经验的事情，而且靠近大脑。我要求他为我写下来，后来在互联网上查找了它，并发现了一些令人恐惧的统计数据。”
雌激素母细胞瘤（ENB），也称为嗅觉神经母细胞瘤，是上鼻腔和前颅底的罕见恶性肿瘤。据信它是由嗅觉神经上皮层产生的，该神经上皮层排在丝布状板，鼻中隔的上方，中涡轮膜和上涡轮上的上方。嗅觉神经上皮含有介导嗅觉的专业受体细胞。ENB最初是由Berger和Luc在1924年描述的，现在被认为占所有恶性鼻肿瘤的百分之几。ENB发生在较大的年龄范围内，在第二十年和第五个十年中具有双峰年龄分布，大多数患者在五十多岁和六十年代。它具有转移到颈部淋巴结的倾向，而与体内远处的区域相比少得多。没有已知的特定原因或危险因素来发展该肿瘤。ENB往往会缓慢生长，患者生存20年，或者迅速随着广泛的转移而迅速生存，生存限制为几个月。由于与ENB相关的许多症状类似于炎症性疾病和鼻腔腔的其他良性疾病，因此诊断通常会延迟。从症状发作到诊断的平均时间为6到12个月。 As a result, many patients have an advanced stage by the time they are diagnosed.
他的当地耳鼻喉科医生将怀特派往休斯敦与McGovern医学院的Otorhinolaryngology-negolaryngology-nead和Neck Surgery系主任Martin J. Citardi，Martin J. Citardi，莫托尔诺肾元素学院主任兼Otorhinolaryngology Hermann-Texas Medicalngology Hermann-Texas医疗中心。Citardi博士是德克萨斯州骷髅基地医生（www.texasskullbase.org）的成员，这是一个多专业计划，在颅底肿瘤和病变的诊断和管理方面具有专业知识。
White recalls how grateful he was that his ENT in Austin paved the way for him. “I was able to see Dr. Citardi as soon as he returned from vacation, and Dr. Citardi had all of the information from the biopsy and my care in Houston.”
White was examined and evaluated by Dr. Citardi, who ordered an MRI. “We already had a diagnosis of esthesioblastoma, and the pattern on the MRI was consistent with the diagnosis,” Dr. Citardi says. “The first thing we do in cases like this is define the extent of the lesion. Patients with a large intracranial component are usually treated with chemotherapy and radiation therapy up front, before surgery. Kurtis’s tumor—although it was large and bulky– was more limited and located entirely within the sinuses.”
Citardi博士第二天预先安排了医院多学科肿瘤委员会的会议。经过审查和讨论此案，医师（从医学肿瘤学，放射肿瘤学和神经放射学的专业）都表明可以通过手术治疗肿瘤。
传统的手术方法ENB青睐by many institutions and authors, is craniofacial resection. “A neurosurgeon does a frontal craniotomy to allow approach to the sinuses from above, and the ENT surgeon does a lateral rhinotomy or midfacial degloving to approach the sinuses from below,” Dr. Citardi says. “But for the past few years, we’ve been removing most tumors and any involved structures effectively using an endoscope through the nose.”
From the patient’s standpoint, there’s a dramatic difference between the traditional approach and the endoscopic approach. Hospitalization for endoscopic transnasal resection is a fraction of the length of stay for the open procedure, and patients avoid the difficult recovery associated with craniotomy. Cumulative experiences across institutions confirm that tumor control rates are comparable between the ‘open’ and the minimally invasive approaches.
怀特计划迅速进行手术。他知道该程序会带来一些风险。Citardi博士说：“我们正在通过插入鼻孔的内窥镜进行工作，并拆卸鼻窦。”“从定义上讲，我们靠近眼睛和其他关键结构。在他的手术过程中，我们取样了硬脑膜，幸运的是没有癌症。在手术结束时，我们必须修复颅底的缺陷。”怀特住院三天，在家休息了一周，几天后返回工作。从他的手术开始不到3周的时间里，他开始了德克萨斯州立大学圆形岩石校园的工商管理硕士学位的课程。
Citardi博士指出，尽管该患者采用的策略是微创，内窥镜手术，但它不是常规的鼻窦手术，并且具有开放颅骨基础手术的风险和复杂性。“为了实现我们的目标，我们需要对通过鼻孔发挥作用的鼻窦进行根本性拆卸。从技术的角度来看，该过程涵盖了过去25年中几乎所有的内窥镜技术。”
Among the advantages of the minimally invasive, endoscopic approach is the rapid recovery. “White’s postop recovery really is not that unusual. And, we can give patients this speedy recovery without compromising the extent of surgery,” Dr. Citardi observes. “Kurtis healed very well,” Dr. Citardi says. “We had negative margins on the final pathology, and he didn’t have to undergo radiation. From the physician standpoint, his recovery was unremarkable, which is the outcome we’re after. His local ENT had given us a lot of information up front and done a good job of getting things started so that the handoff to us was smooth. We scheduled the office appointment and MRI, lined up the tumor board, and when Kurtis came in Everything was in the right place at the right time.”
“I know this sounds strange when you’re dealing with cancer, but it was a wonderful experience,” White says. “Given that I learned I had a rare form of cancer, and in light of all that could have happened, I was surprised at how smoothly everything went. I was happy to learn that I wouldn’t need chemotherapy and radiation. It was downright miraculous, in fact. I’m grateful to my ENT here in Austin for the referral to Dr. Citardi, who walked us through all the steps and got things moving quickly. If you have to go through an experience like this, this is the way to do it.”
