经上颌骨翻转入路手术切除斜坡脊索瘤

Transmaxillary approach for surgical removal of clival chordomas: study of 10 cases

目的探讨采用经上颌骨翻转入路手术切除Al-MeftyⅢ型斜坡脊索瘤的方法及临床意义.方法对10例Al-MeftyⅢ型斜坡脊索瘤患者,采用经上颌骨翻转入路的手术方法切除肿瘤.术后随访10～56个月,平均34个月. 结果 8例患者在显微镜下肿瘤被全部切除,2例次全切除(切除90%以上).3例患者分别在术后26、36、40个月带瘤生存,其余7例恢复正常生活.手术并发症包括:创腔感染1例,脑脊液漏1例,咽喉部肿胀致阻塞性通气困难1例,均经保守治疗痊愈. 结论经上颌骨翻转入路手术切除Al-MeftyⅢ型斜坡脊索瘤具有显露充分、肿瘤切除彻底、不损伤脑组织的优点,疗效满意.

Objective To study the effectiveness and clinical significance of transmaxillary approach for surgical removal of Al-Mefty typeⅢ clival chordomas. Methods Ten cases of Al-Mefty typeⅢ clival chordoma were treated via the transmaxillary approach and followed up for 34 months on average (10~56 months). Results Microscopic total removal of the tumors was achieved in 8 patients, and subtotal removal was achieved in the rest 2 patients. Three patients had tumor recurrence but still lived with tumors 26, 36, and 40 months after operation. The other 7 patients resumed their routine life without tumor. The postoperative complications included infection in 1 case that was cured by antibiotic therapy, postoperative obstructive dyspnoea in 1 case that required tracheostomy, and CSF leakage in 1 case that stopped spontaneously 3 weeks after operation. Conclusion With better exposure, complete removal, and with less brain damages and satisfactory results, transmaxillary approach is effective for surgical treatment of Al-Mefty type Ⅲ clival chordomas.