Dehdashti Amir R, Karabatsou Konstantina, Ganna Ahmed, Witterick Ian, Gentili Fred
Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Canada.
Neurosurgery. 2008 Aug;63(2):299-307; discussion 307-9. doi: 10.1227/01.NEU.0000316414.20247.32.
We report our recent experience with an expanded purely endoscopic endonasal approach for the treatment of clival chordomas.
Twelve patients underwent an expanded endoscopic approach for excision of cranial base chordomas at Toronto Western Hospital. Two patients had undergone a previous craniotomy for excision of a significant lateral intracranial extension of the tumor. All other patients had mainly centrally located lesions. Three patients had recurrent tumors. This study focused on the surgical approach, results, and complications associated with this approach.
Diplopia caused by VIth nerve palsy was the most common presenting symptom and was observed in seven patients. Gross total resection of the tumor was achieved in seven patients (58%). Four patients had complete recovery of their preoperative diplopia. One patient (8%) presented with new hemiparesis postoperatively. Four patients (33%) had a cerebrospinal fluid leak postoperatively; two were treated by lumbar drainage, and two required a secondary surgical repair. All newly diagnosed patients underwent adjuvant radiotherapy. There was no mortality. The short-term outcome was excellent in all but one patient. No recurrence was observed at the median follow-up period of 16 months.
The expanded endoscopic endonasal approach is a valid minimally invasive alternative for the treatment of centrally located clival chordomas or as an adjunct for the central part of chordomas with lateral extension. The early results of this technique indicate at least equivalency to more extensive open approaches, and its versatility may widen the horizon of surgical management of these aggressive lesions. The challenge with the cerebrospinal fluid leakage is being addressed with novel local flap repair techniques. This approach should be in the armamentarium of cranial base surgeons as an option in the management of clival chordomas.
我们报告近期采用扩大的单纯鼻内镜经鼻入路治疗斜坡脊索瘤的经验。
12例患者在多伦多西部医院接受扩大鼻内镜入路切除颅底脊索瘤。2例患者曾接受开颅手术切除肿瘤显著的颅内外侧延伸部分。所有其他患者主要为中央型病变。3例患者为复发性肿瘤。本研究重点关注手术入路、结果以及该入路相关的并发症。
由第六脑神经麻痹引起的复视是最常见的首发症状，7例患者出现该症状。7例患者（58%）实现了肿瘤全切。4例患者术前复视完全恢复。1例患者（8%）术后出现新的偏瘫。4例患者（33%）术后发生脑脊液漏；2例通过腰大池引流治疗，2例需要二次手术修复。所有新诊断患者均接受辅助放疗。无死亡病例。除1例患者外，所有患者短期预后良好。在16个月的中位随访期内未观察到复发。
扩大的鼻内镜经鼻入路是治疗中央型斜坡脊索瘤或作为伴有外侧延伸的脊索瘤中央部分辅助治疗的一种有效的微创替代方法。该技术的早期结果表明至少与更广泛的开放手术方法相当，其多功能性可能拓宽这些侵袭性病变手术治疗的视野。脑脊液漏的挑战正通过新型局部皮瓣修复技术得到解决。这种入路应作为颅底外科医生治疗斜坡脊索瘤的一种选择纳入其手术方法库。
