鼻内镜联合显微外科手术治疗前中颅底沟通性肿瘤的手术疗效分析(附38例报告)

Endoscopic endonasal surgery combined with microsurgery for the treatment of anterior and middle cranial fossa tumors:A report of 38 cases

目的:探讨鼻内镜联合显微外科手术治疗前中颅底广泛沟通性肿瘤的临床疗效。方法:回顾性分析2015年7月至2017年12月首都医科大学附属北京同仁医院神经外科收治的38例前中颅底沟通性肿瘤患者的临床资料。所有患者均行鼻内镜联合显微外科手术治疗,且同期行颅底重建术;其中16例行常规颅底重建,13例患者行鼻中隔黏膜颅底重建,9例行额窦引流、颅底重建术。术后进行临床和影像学评估,观察肿瘤全切除率、并发症发生率。随访术后12个月时肿瘤复发率及患者生存率。结果:38例患者中,肿瘤全切除27例(71.0%),近全切除8例(21.1%),部分切除3例(7.9%)。术后组织病理学检查结果显示,内翻状乳头状瘤伴不典型增生6例,鳞癌5例,恶性黑色素瘤5例,腺样囊性癌4例,内翻状乳头状瘤4例,腺癌3例,软骨肉瘤3例,嗅神经母细胞瘤2例,孤立性纤维性肿瘤、血管外皮瘤、淋巴上皮癌、胚胎性横纹肌肉瘤、脑膜瘤及肌上皮癌各1例。38例患者中,35例术后未出现脑脊液漏,颅底重建效果良好;3例(7.9%)出现一过性脑脊液漏合并颅内感染,1例(2.6%)出现视力下降,3例(7.9%)眼球活动受限;无一例出现额窦炎。38例患者的随访时间为(14.5±2.8)个月(12~18个月)。术后12个月,38例患者的生存率为100%,其中5例(13.2%)患者肿瘤复发。结论:鼻内镜联合显微外科手术治疗累及前中颅底的沟通性肿瘤,同期行颅底重建术,短期疗效良好,术后脑脊液漏、颅内感染等并发症较少。

Objective To explore the clinical efficacy of endoscopic endonasal surgery combined with microsurgery in the treatment of extensive tumors in the anterior and middle cranial fossa.Methods A retrospective analysis was conducted on the clinical data of 38 patients with anterior and middle cranial fossa tumors admitted to Department of Neurosurgery,Beijing Tongren Hospital,Capital Medical University from July 2015 to December 2017.All patients underwent endoscopic endonasal surgery combined with microsurgery,and skull base reconstruction was performed during the same time period.Among them,16 patients underwent conventional skull base reconstruction,13 underwent nasal septum mucosa skull base reconstruction,and 9 patients underwent frontal sinus drainage and skull base reconstruction.Postoperative clinical and imaging evaluations were performed to document the gross total tumor resection rate and the incidence of complications.The tumor recurrence rate and patient′s survival rate were followed up at 12 months post operation.Results Among all 38 patients,total resection of tumor was achieved in 27 cases(71.0%),subtotal resection in 8 cases(21.1%),and partial resection in 3 cases(7.9%).Postoperative histopathological examination indicated inverted papilloma with dysplasia in 6 cases,squamous cell carcinoma in 5,malignant melanoma in 5,adenoid cystic carcinoma in 4,inverted papilloma in 4,adenocarcinoma in 3,chondrosarcoma in 3,olfactory neuroblastoma in 2,solitary fibrous tumor in 1,hemangiopericytoma in 1,lymphoid epithelial carcinoma in 1,embryonic rhabdomyosarcoma in 1,meningioma in 1 and myoepithelial carcinoma in 1.Among 38 patients,35 cases did not have cerebrospinal fluid leakage after operation,and the skull base reconstruction effect was good;3 cases(7.9%)developed transient cerebrospinal fluid leakage and intracranial infection,1 case(2.6%)had vision loss,and 3 cases(7.9%)had restricted eye movements.There was no frontal sinusitis.The follow-up time of 38 patients was 14.5±2.8 months(12-18 months).At 12 months post surgery,the survival rate of 38 patients was 100%,and 5 patients(13.2%)had tumor recurrence.Conclusion Endoscopic endonasal surgery combined with microsurgery for the treatment of tumors involving the anterior and middle cranial fossa,with skull base reconstruction performed at the same time,seems to have good short-term efficacy and relatively few complications such as postoperative cerebrospinal fluid leakage and intracranial infection.