经鼻内镜手术治疗颅底脊索瘤

Transnasal endoscopic surgery for skull base chordoma

脊索瘤是一种起源于胚胎发育时期残留脊索组织的先天性低恶性肿瘤,多发生于骶尾部及颅底中线部位,尤其是斜坡区域,其预后与肿瘤切除程度密切相关,肿瘤完全切除的患者多能长期生存.由于颅底脊索瘤多呈浸润性生长,侵袭范围广,累及颅底重要神经、血管及脑组织等,手术完全切除极其困难,因此被认为是神经外科治疗的难题之一.近年来随着神经内镜技术的发展,以及术中神经导航系统、电生理监测、经鼻超声系统和多普勒超声血管探测仪等监测技术的广泛应用,经鼻内镜入路能在直视下最大可能地安全切除颅底脊索瘤,并尽可能保留重要神经、血管功能,其手术创伤小,术后脑脊液漏等并发症发生率低,并且患者生存质量明显提高,已成为颅底脊索瘤手术治疗的首选方法.为进一步全面认识经鼻内镜治疗颅底脊索瘤的疗效及优缺点,我们查阅了近年来国内外公开发表关于经鼻内镜手术治疗颅底脊索瘤的相关文献,并从术前肿瘤评估分型、手术策略、肿瘤手术切除程度及其影响因素以及术后并发症等几方面对其进行综述.

Chordoma is a congenital low-grade maligna nt tumor originating from residual chordal tissue during embryonic development, which mostly occurs in sacrococcygeal region and midline of skull base, especially in clivus region. The prognosis of chordoma is closely related to the degree of tumor resection. Most patients with complete resection of the tumor can survive for a long time. Because most of skull base chordomas are infiltrative and invasive, involving important nerves, blood vessels and brain tissue in the skull base, complete resection is extremely difficult. So chordoma in skull base is considered to be one of neurosurgical challenges. In recent years, with the development of neuroendoscopy technology and the wide application of intraoperative monitoring techniques such as neuronavigation system, intraoperative electrophysiological monitoring, intraoperative transnasal ultrasound system and doppler ultrasound blood vessel detector, transnasal endoscopic approach can safely resect skull base chordoma under direct vision and retain important neurovascular function as far as possible, with minimal surgical trauma and postoperative complications. The incidence of complications such as cerebrospinal fluid leakage is low, and the quality of life of patients has been significantly improved. Transnasal endoscopic approach has become the preferred method for surgical treatment of skull base chordoma. In order to further understand the efficacy, advantages and disadvantages of transnasal endoscopic surgery for skull base chordoma, we reviewed the published literature on transnasal endoscopic surgery for skull base chordoma in recent years and discussed the treatment of skull base chordoma by transnasal endoscopic surgery from the aspects of preoperative evaluation and classification of tumors, surgical strategies, degree and influencing factors of resection of tumors, and postoperative complications.