天津医药

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鼻内镜联合神经导航经鼻入路治疗颅底脊索瘤

杭伟,刘刚,张金玲   

  1. 天津市环湖医院
  • 收稿日期:2010-04-07 修回日期:2010-05-07 出版日期:2011-01-15 发布日期:2011-01-15
  • 通讯作者: 杭伟

Endoscopic transnasal approach and neuronavigation for surgical treatment of skull base chordomas

  • Received:2010-04-07 Revised:2010-05-07 Published:2011-01-15 Online:2011-01-15

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摘要： [摘要] 目的: 探讨鼻内镜联合神经导航经鼻入路治疗颅底脊索瘤的手术方法,临床效果。方法: 回顾性分析25例颅底脊索瘤病人的病例资料,均采用鼻内镜联合神经导航经鼻蝶手术入路。结果: 肿瘤全切除9例, 次全切除13例, 部分切除3例。术后临床症状得到不同程度改善20例, 无明显缓解5例。未出现脑脊液鼻漏、颅内感染等手术并发症, 无死亡病例。部分切除病例中, 术后12个月复发1例, 术后3年复发伴远处部位转移1例，均带瘤生存。结论: 鼻内镜联合神经导航经鼻入路最适宜切除病变局限于鞍区或中、上斜坡,大部在硬膜外、生长到鼻窦、鼻腔、鼻咽部的肿瘤。鼻内镜联合神经导航经鼻蝶入路手术治疗颅底脊索瘤是一种安全、有效、创伤小、容易操作、省时的手术方法,疗效满意。

关键词: 脊索瘤, 内镜外科, 神经导航, 经鼻蝶入路

Abstract: [Abstract]　Objective: To discuss the surgical method and clinical effect of endoscopic transnasal approach and neuronavigation to resect chordomas of skull base. Methods: Twenty-five cases of chordomas operated via transsphenoidal sinus approach were retrospectively analyzed. Results: Tumor was totally removed in 9 patients, subtotally in 13, and partially in 3. Clinical symptoms of 20 patients were relieved after operation, and not relief in 5. There was no operative death or any postoperative complications. During the follow-up periods, tumor recurred in about 12 months after operation in 1 cases only got partial resection of the tumor, and recurred 3 years after operation which metastasized to the distal organs in 1. Conclusion: Endoscopic transnasal approach and neuronavigation is adapted to resect chordomas of saddle area or middle and upper clivus and those lesions involving nasal cavity, nasal sinuses and nasopharynx. Endoscopic transnasal approach and neuronavigation has many advantages, such as safety, efficiency, minimal invasion, simple manipulation, timesaving, good results.

Key words: chordomas, endoscopic surgery, neuronavigation, transsphenoidal approach