经鼻神经内镜与开颅治疗颅底脊索瘤病例对照研究

A case-control study of endoscopic endonasal approach and transcranial approach in the treatment of skull base chordomas

目的探讨经鼻神经内镜与开颅显微镜治疗颅底脊索瘤的手术结果及手术策略选择。方法回顾性分析2010年1月至2020年9月环湖医院经病理确诊的31例颅底脊索瘤患者临床资料。按手术方式分为经鼻神经内镜组与开颅显微镜组,比较两组的临床结局。结果经鼻内镜组18例,全切除7例,次全切除9例,部分切除2例,主要并发症包括死亡2例,脑脊液漏8例,脑神经损伤2例,垂体功能减退1例;开颅显微镜组13例,全切除2例,次全切除10例,部分切除1例,主要并发症为脑脊液漏1例,脑神经损伤3例,癫痫1例、硬膜外血肿1例。两组全切除率比较无统计学差异(P>0.05)。经鼻内镜组发生脑脊液漏的比例(44.4%)明显高于开颅显微镜组(7.7%),比较具有统计学意义(P<0.05)。肿瘤术后复发或进展的比较无统计学意义(P>0.05)。结论经鼻内镜切除颅底脊索瘤的全切率有所提高,但传统开颅手术仍是目前颅底脊索瘤治疗的重要选择,需根据肿瘤的生长及延伸位置合理的选择手术入路。

Objective To investigate the surgical outcomes and strategies selection of endoscopic endonasal approach and craniotomy in the treatment of cranial base chordomas.Methods Thirty-one patients diagnosed pathologically with cranial base chordoma in Tianjin huanhu hospital from Jan.2010 to Sep.2020 were analyzed retrospectively.The patients were divided into the endoscopic endonasal group and the craniotomy microscope group according to the different surgical approaches.The surgical results and follow-up between the two groups were compared.Results In the endoscopic endonasal group,there were 7 cases of gross total resection,9 cases of subtotal resection and 2 cases of partial resection.The main complications included death in 2 cases,cerebrospinal fluid leakage in 8 cases,cranial nerve injury in 2 cases and hypopituitarism in 1 case.In the craniotomy microscope group,there were 2 cases of gross total resection,10 cases of subtotal resection,and 1 case of partial resection.The main complications included cerebrospinal fluid leakage in 1 case,cranial nerve injury in 3 cases,epilepsy in 1 case and epidural hematoma in 1 case.There was no statistical significance in the resection rate between the two groups(P>0.05).The rate of cerebrospinal fluid leakage in the endoscopic group was significantly higher than that in the craniotomy microscope group,and the comparison was statistically significant(P<0.05).There was no statistically significant between the two groups for tumor recurrence or progression.Conclusions The endoscopic endonasal approaches for resection of cranial base chordomas have improved the gross total resection rate,but craniotomy is still an important surgical method for tumor resection.It is necessary to select an appropriate surgical approach according to the lesion location and pattern of tumor growth.