额下入路联合鼻内镜切除鼻颅交通型肿瘤12例临床分析

Subfrontal approach for nasal-cranial communicans tumor resection with nasal endoscope:analysis of 12 cases

目的探讨经额下入路联合鼻内镜切除鼻颅交通型肿瘤的手术方法和临床疗效。方法 12例鼻颅交通型肿瘤患者中脊索瘤6例(硬膜外型5例、硬膜内-外型1例),脑膜瘤5例(硬膜内-外型),内翻性乳头状瘤1例(硬膜外型),均于耳鼻咽喉头颈外科医师的协助下经额下入路联合鼻内镜切除鼻腔及鼻窦内残余肿瘤。结果肿瘤完全切除者11例,大部切除者1例。手术后并发症主要包括精神症状(1例)、脑脊液鼻漏(2例)、嗅觉减退或丧失(3例),其中5例患者经对症治疗痊愈;无一例发生手术后感染或死亡。随访3个月～7年,1例脊索瘤和1例内翻性乳头状瘤患者复发。结论额下入路联合鼻内镜手术切除鼻颅交通型肿瘤安全、有效。

Objective To explore the methods and effects of operation via subfrontal approach with nasal endoscope for removing nasal-cranial communicans tumor. Methods Clinical data of 12 patients who underwent operation for nasal-cranial communicans tumor via subfrontal approach with nasal endoscope were analysed retrospectively. The lesions included chordoma in 6 cases （extradural, 5; intradural- extradural, 1）, meningioma in 5 cases （intradural- extradural） and inverted papilloma in one case （extradural）. Bilateral frontal coronal incision and frontal craniotomy were performed. Frontal lobe was detached for exposing anterior skull base. Tumor in cranial part was removed by neurosurgeon with microscope, and residual neoplasm in nasal cavity was removed by otorhinolaryngologist with nasal endoscope. Results The tumors were totally removed in 11 cases. Greater part incision was performed in one case. Postoperative complications were mental symptom （one case）, cerebrospinal rhinorrhea （2 cases）, and hyposmia or anosphrasia （3 cases）. Conclusion The subfrontal approach and nasal endoscope is more safe and effective for removing nasal-cranial communicans tumor.