内镜经鼻入路治疗侵犯斜坡硬膜内外沟通型脊索瘤

Nasal endoscopic resection of extended intradurally clival chordoma

目的 总结采用单纯内镜经鼻入路切除斜坡硬膜内外沟通型脊索瘤的初步经验及围手术期处理的体会.方法 2007年12月至2009年12月我们采用单纯内镜经鼻入路（其中有4例联合了内镜经口入路）对7例斜坡硬膜内外沟通型脊索瘤患者实施了外科治疗.其中2例为斜坡脊索瘤术后复发侵犯斜坡硬膜内,1例为放疗及伽马刀治疗后效果不明显的病例.本组中男4例,女3例;年龄8～62岁,中位年龄25岁.临床症状：头颈痛2例次,复视2例次,鼻塞1例次,脑脊液鼻漏2例次,行走不稳2例次,声嘶2例次.结果 6例为完全切除,1例为次全切除.术后随访3～25个月,中位随访时间22个月.全切的6例中有1例复发,带瘤生存至今.次全切除的1例没有再接受治疗,于术后10个月死于病情进展.除1例患者术后出现暂时的脑脊液鼻漏外,其他患者无术中及术后并发症发生.结论 内镜经鼻入路可以处理斜坡硬膜内外沟通型脊索瘤,该入路外科创伤小,视觉效果好,对深部解剖结构辨认清晰,双人双侧鼻腔操作可以较好地显露和处理病变.但该入路对术者的颅底解剖知识、内镜外科技术以及围手术期处理经验均有极高的要求.

Objective Clival chordoma with intradural extension is very difficult to manage mont.Primary experience of nasal endoscopic surgery for the extra-intra clival chordomas was reported. Methods Between 2007 and 2009,7 patients （4 males and 3 females,ages ranging from 8 to 62 years） with clival extra-intra dural chordoma underwent nasal endoscopic surgeries, 4 of them with combined transoral approach. Charts were reviewed for clinical characteristics, previous therapies, tumor extent, management modalities,complications, and outcome. Results Total resection of tumor was obtained in 6 cases and subtotal resection in one case. Postoperative follow-up period ranged from 3 to 25 months, median 22 months. One of 6 cases with total resection was recurrent and alive with disease. The patient with subtotal resection died secondary to progression of disease 10 months after the surgery. There was no intraoperative complication. Expect for one case of transient cerebral spinal fluid leakage, no postoperative complication was encountered. Conclusions Nasal endoscopic approach may provide a less invasive surgery for clival chordoma with intradural extension. It is safe and effective when it is performed by the surgeons with adequate experience and skills and perioperative managements were taken.