神经内镜下经扩大鼻蝶入路手术切除颅咽管瘤

Endosope-assisted neurosurgery through extended endonasal transsphenoidal approach for craniopharyngiomas

目的探讨神经内镜经扩大鼻蝶入路手术切除颅咽管瘤的安全性和有效性。方法回顾性分析2014年11月至2017年11月神经内镜经扩大鼻蝶入路手术切除的18例颅咽管瘤的临床资料。结果肿瘤全切除9例,近全切除7例,次全切除2例。术前视力、视野损伤16例中,10例好转;术前认知功能下降5例中,4例改善;术前皮质醇下降9例中,6例恢复正常;术前皮质醇正常9例中,2例皮质醇下降;术前尿崩3例中,1例缓解;术后发生一过性尿崩10例,1周后好转。术后脑脊液鼻漏1例(5.6%),保守治疗后好转。术后随访7～55个月,中位随访时间23.5个月,MRI未见肿瘤进展或复发。结论神经内镜下经扩大鼻蝶入路手术切除颅咽管瘤安全、有效,关键是术前充分评估、掌握好适应证,术中保护好神经和血管、妥善修补颅底。

Objective To investigate the curative effects of endoscope-assisted neurosurgery through extended endonasal transsphenoidal approach(EETA) on craniopharyngiomas and its safety. Methods The clinical data of 18 patients with craniopharynbgiomas undergoing endoscope-assisted neurosurgery through EETA from November, 2014 to November, 2017 were analyzed retrospectively. Results Of 18 patients with craniopharynbgiomas, 9 received total removal of the tumors and 9 subtotal. Of 16 patients with preoperative visual acuity defect, 10 were obviously improved in the visual acuity defect and 6 not. Of 5 patients with preoperative cognitive function decline, 4 mended and 1 not. Of 9 patients with normal preoperative cortisol level, 2 had low cortisol level and 7 normal after the operation. Of 9 patients with low preoperative cortisol level, 6 had normal cortisol level and 3 not after the surgery. Ten patients who suffered from transient diabetes insipidus after the operation mended 1 week after the operation, and of 3 patients with preoperative diabetes insipidus, 1 was improved and 2 not after the operation. One patients who suffered from cerebrospinal fluid leak after the operation mended by the conservative treatment. The postoperative MRI revealed no tumor progress or recurrence in all the patients 7~55 months after the operation. Conclusions Sufficient preoperative evaluation, and avoiding intraoperative neurological injury and reconstructing the skull base are essential for the successful resection of craniopharyngioma by endosopeassisted neurosurgery through EETA.