经鼻内镜斜坡脊索瘤和脊索肉瘤的外科治疗

Endoscopic endonasal surgery for clival chordoma and chordosarcoma

目的探讨经鼻内镜外科技术在斜坡脊索瘤和脊索肉瘤治疗中的应用。方法2002年11月￣2006年2月对7例脊索瘤和2例脊索肉瘤行经鼻内镜手术,其中3例是复发病例。所有病例均有头痛,复视4例,视力障碍或失明3例,鼻塞、嗅觉减退或失嗅4例,面部麻木1例。肿瘤同时侵犯海绵窦和颈内动脉4例,岩尖区5例,寰枢椎2例。随访时间3￣39个月。结果6例脊索瘤和1例脊索肉瘤术中内镜下及术后影像学证实完全切除,1例脊索瘤和1例脊索肉瘤次全切除。1例术后出现蛛网膜下腔出血。至随访期结束,7例病人无复发。1例带瘤生存。1例行脊索瘤次全切除的病人5个月后复发。结论经鼻内镜治疗斜坡脊索瘤和脊索肉瘤可以更好地辨认深部结构,视觉效果好,可以大范围切除病变。同时,可以简单迅速地到达斜坡区域。对斜坡脊索瘤和脊索肉瘤是一种较好的手术入路。

Objective To explore application of endoscopic endonasal approach in surgery for clival chordoma and chordosarcoma. Methods Seven patients with chordoma and 2 with chordosarcoma were managed by endoscopic endonasal surgery during November 2002 to February 2006. Three cases of all the patients were relapse. Headache presented in all the patients, diplopia in 4, visual dysfunction or blindness in 3, nasal obstruction and hyposmia or anodmia in 4 and facial numbness in 1. Tumors invaded both the cavernous sinus and internal carotid in 4 cases, petrous apex in 5 and the atlantoaxial region in 2. Follow-up periods ranged from 3 to 39 months. Results Total removal was achieved in 6 cases of chordoma and 1 chordosarcoma, and subtotal removal in 1 chordoma and 1 chordosarcoma. Postoperative subarachnoid hemorrhage occurred in 1 patient. At last follow-up, 7 patients had no relapse and 1 was alive with disease. The chordoma had recurred in 1 patient after 5 months with subtotal removal. Condusion Endoscopic endonasal approach can provide a better visualization of the deeper anatomical structures in the skull base, an ability to ＇look around comers＇ and a large surgical field. In addition, it promises a simple and rapid access to the clivus. Therefore it is a safe and efficient surgical approach for clival chordoma and chordosarcoma.