个性化内镜技术在经鼻入路岩斜区病变手术中的应用

Application of personalized endoscopic techniques in surgery of endonasal resection of petroclival lesions

研究背景岩斜区位于颅底,位置深在,周围解剖结构复杂,给手术安全切除该部位病变带来极大挑战。目前岩斜区病变的手术入路主要有开颅经侧方入路和内镜下经鼻入路。本研究探讨内镜技术在经鼻入路岩斜区病变手术中的应用及其有效性和安全性。方法纳入2018年1月至2020年12月在福建医科大学附属第一医院治疗的6例岩斜区病变患者,均行神经导航辅助内镜下经鼻入路岩斜区病变切除术。结果 6例患者均顺利完成手术,平均手术时间4.53 h。术后病理证实3例为软骨肉瘤(WHO 2级2例、WHO 1级1例),1例神经鞘瘤,1例脊索瘤,1例胆固醇肉芽肿。除1例术后视物重影症状未缓解外,余5例术前症状均不同程度缓解。术后平均住院5.67 d,中位随访时间14.07个月。术后3个月内均未出现脑脊液漏、中枢神经系统感染、脑神经损伤等并发症,未行非计划二次手术,无死亡病例;截至末次随访,均无病变复发。结论神经导航辅助内镜下经鼻入路岩斜区病变切除术相对安全、有效。术中应根据肿瘤部位和大小个性化选择不同的内镜技术。

Background The petroclival area is located deep at the base of the skull,and the surrounding anatomical structure is complex,which brings great challenges to the safe removal of the lesions in this part of the operation.At present,the main surgical approaches for petroclival lesions are lateral craniotomy and endoscopic endonasal approach.This study explored the effectiveness and safety of endoscopic techniques in the resection of petroclival lesions via endonasal approach.Methods A total of6 patients with petroclival lesions treated in The First Affiliated Hospital of Fujian Medical University from January 2018 to December 2020 were included.All patients underwent neuronavigation assisted endoscopic endosnasal approach resection of petroclival lesions.Results All the 6 patients successfully completed the operation.The average operation time was 4.53 h.After the operation,3 cases were pathologically confirmed as chondrosarcoma(2 cases of WHO grade 2,one case of WHO grade 1),one case of schwannoma,one case of chordoma and one case of cholesterol granuloma.Except for one case of preoperative double vision that did not relieve postoperatively,the remaining 5 cases had preoperative symptoms alleviated to varying degrees.The average postoperative hospital stay was 5.67 d.The postoperative median follow-up was 14.07 months.There were no complications such as cerebrospinal fluid leakage,central nervous system infection,cranial nerve damage,no unplanned secondary operations,and no deaths within 3 months after the operation.Up to the last follow-up,no patients had recurrence.Conclusions Neuronavigation assisted endoscopic endonasal approach resection of petroclival lesions is relatively safe and effective.Different endoscopic techniques should be selected according to the tumor location and size.