颅底骨巨细胞瘤的诊断治疗

Diagnosis and treatment of giant cell tumor of skull base

目的探讨颅底骨巨细胞瘤的诊断和治疗原则。方法对2007年8月~2017年4月经病理证实的14例颅底骨巨细胞瘤的治疗经验进行总结。结果 14例患者中有8例肿瘤位于颞骨,5例位于蝶骨,1例位于筛骨。手术分别采用内镜经鼻入路、经颞下窝入路、内镜经鼻联合颞下窝入路、经颅中窝入路。其中11例完成肿瘤全切,3例次全切除。手术未出现明显严重并发症。术后患者经过8个月至10年的随访,其中2例患者接受了放疗,所有患者肿瘤均无明显复发或进展。结论发生在颅底的骨巨细胞瘤较罕见,诊断困难,但临床、影像学等仍有其特点,手术是首选的治疗方法,手术入路需个体化制定。

Objective To explore the diagnosis and treatment principle of giant cell tumor of skull base. Methods The experience in the treatment of pathologically confirmed giant cell tumor of skull base in 14 cases admitted in our hospital from Aug 2007 to April 2017 was summarized. Results Of all the 14 cases,tumor involved temporal bone in 8,sphenoid bone in 5 and ethmoid bone in one. The surgical approaches included endoscopic endonasal approach（ EEA）,infratemporal fossa approach（ ITFA）,combined EEA and ITFA approach and middle cranial fossa approach（ MCFA）.Total tumor removal was achieved in 11 patients,while subtotal removal was achieved in 3. There were no severe surgical complications. All the patients had been followed up for 8 months to 10 years. Two in the three patients who could not get total tumor removal received postoperative radiotherapy. None of the 14 cases got tumor recurrence or progression.Conclusions Giant cell tumor of skull base is rare and difficult to be diagnosed. Certain characteristics can be found in clinic and radiology. Surgery is the preferred treatment method for this tumor. The choice of surgical approach should be individualized.