以脑脊液鼻漏为首发症状斜坡脊索瘤的诊断及内镜外科治疗

Diagnosis and endoscopic surgery of clival chordoma with cerebrospinal fluid rhinorrhea as initial symptom

目的探讨以脑脊液鼻漏为首发症状的斜坡脊索瘤的诊断及内镜外科治疗。方法回顾性分析2例以脑脊液鼻漏为首发症状的斜坡脊索瘤病人的临床资料,均在内镜下确诊,并行内镜经鼻入路肿瘤切除术及脑脊液鼻漏修补术。结果肿瘤全切除2例,脑脊液鼻漏均修补成功。随防17～22个月,无肿瘤及脑脊液鼻漏复发。结论对于斜坡脑脊液鼻漏应高度警惕脊索瘤的存在,内镜下经鼻入路既是术中发现病变的手段,又是切除斜坡病变及行脑脊液鼻漏修补的治疗方式。

Objective To investigate the diagnosis and endoscopic surgery of clival chordoma with cerebrospinal fluid rhinorrhea（CSFR） as initial symptom.Methods Clinical data of 2 patients with clival chordoma causing CSFR as initial symptom was analyzed retrospectively.The diagnosis in all the cases was confirmed by endoscopy,and the tumors resection and repair were preformed via endonasal approach.Results Total tumor resection was achieved in the 2 patients and their CSFR was also repaired successfully.During a follow-up period of 17 to 22 months,there was no tumor and CSFR recurrence.Conclusions A surgeon in cerebral surgery should be alert for chordoma for the patients with clival CSFR.Endoscopic endonasal approach is not only the means of finding lesions,but also the best treatment modality for resection of clival lesions and repair of CSFR.