神经内镜下扩大经鼻蝶窦入路治疗颅咽管瘤

Extended endoscopic endonasal transsphenoidal approach for craniopharyngiomas

目的神经内镜下经鼻蝶窦入路术中能够直视肿瘤、无脑组织牵拉,已广泛应用于垂体腺瘤的手术治疗,而扩大经鼻蝶窦入路突破了传统的限制,提高了鞍上肿瘤及海绵窦区域肿瘤的切除率。神经内镜下扩大经鼻蝶窦入路治疗颅咽管瘤的安全性及有效性是目前关注的重点。方法回顾性分析20例颅咽管瘤患者的临床资料,均在神经内镜下行扩大经鼻蝶窦入路鞍区病变切除,结合国内外该入路治疗颅咽管瘤的文献进行讨论。结果20例均实现肿瘤全切除,无死亡病例。15例无任何并发症,4例出现1项并发症,1例出现2项并发症。仅1例术后新发视力、视野损伤;2例新发一过性尿崩;2例出现新发垂体功能减退;2例术中保留垂体柄,垂体功能并未见明显变化;2例术后感染,予抗生素治疗控制良好。术后随访:2例在术后8、18个月垂体核磁示可疑复发,其余最长随诊时间12个月复查时没有任何复发迹象。保留垂体柄的患者术后7个月的随访过程中未出现复发。结论神经内镜下扩大经鼻蝶窦入路切除颅咽管瘤的安全性、有效性均比较乐观。颅底重建技术的发展极大降低术后脑脊液漏发生率,为手术提供了支持与保障。

Objective To evaluate the efficacy and safety of extended endoscopic endonasal transsphenoidal approach （EEETA） for craniopharyngiomas. Methods Clinical data of 20 patients suffering from craniopharyngioma surgically removed via EEETA were analyzed retrospectively with literature review. Results Total tumor excision was achieved in all the 20 patients without death case. No postoperative complications occurred in 15 cases. New-onset visual complication, transient diabetes insipidus and endocrinopathy occurred in 1, 2, and 2 patients respectively. During the follow-up period, possible recurrence was observed by magnetic resonance imaging （MRI） in 2 patients at 8 and 18 months postoperatively. No relapses appeared in the other patients with a longest follow-up period of 12 months. In 2 cases with preserved pituitary stalk, the postoperative pituitary function remained unchanged and no tumor recurred during 7 months＇ follow-up. Conclusion Excision of craniopharyngioma via EEETA demonstrates advantages of good safety and efficacy. Successful skull base reconstruction has provided great support for surgical success by reducing postoperative cerebrospinal fluid leakage and intracranial infection.