Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10065, USA.
Neurosurgery. 2010 Sep;67(3 Suppl Operative):ons150-8; discussion ons158. doi: 10.1227/01.NEU.0000383130.80179.41.
The endoscopic endonasal transclival approach is a novel minimal-access method of managing clival pathology. Limited cases have been published.
To summarize our clinical experience with this approach and discuss technical nuances.
We retrospectively reviewed a prospective database of 250 endoscopic, endonasal skull base surgeries. Patients in whom a transclival approach was performed were identified. Extent of resection, complications, and clinical outcome were analyzed.
Seventeen patients underwent 21 procedures. Pathology included chordoma, meningioma, hemangiopericytoma, enterogenous cyst, epidermoid, and metastasis. Lumbar drain was placed intraoperatively in 9 cases and maintained for approximately 2 days postoperatively. Mean operative time was 252.8 minutes. Intraoperative cerebrospinal fluid (CSF) leak occurred in 10 cases. Greater than 95% resection was achieved in 11 of 12 cases (92%) in which it was the surgical goal. The risk of postoperative CSF leak was 4.8% for all procedures, 9.1% for procedures with large skull base defect, and 0% if a gasket-seal closure was achieved. A nasoseptal flap was used in 2 patients. There was one perioperative infarct, one case of deep vein thrombosis, and one postoperative pulmonary embolus. Mean follow-up was 8.5 months. All but one patient with preoperative cranial nerve deficits improved at last follow-up. All patients were free of disease progression at last follow-up.
The endonasal endoscopic transclival approach provides a minimal-access approach to the ventral midline posterior fossa skull base. The risk of CSF leak is low if appropriate closure techniques are applied.
经鼻内镜颅底切除术是一种治疗颅底斜坡病变的新微创方法。目前仅有少数病例报道。
总结我们应用该方法的临床经验并讨论技术要点。
我们回顾性分析了 250 例内镜经鼻颅底手术的前瞻性数据库，确定了施行经斜坡入路的患者。分析了切除范围、并发症和临床结果。
17 例患者共施行 21 例手术，病理类型包括脊索瘤、脑膜瘤、血管外皮细胞瘤、肠源性囊肿、表皮样囊肿和转移瘤。9 例患者术中放置了腰椎引流管，术后保留约 2 天。平均手术时间为 252.8 分钟。10 例术中发生脑脊液（CSF）漏。在以全切为目标的 12 例患者中，11 例（92%）达到了大于 95%的切除率。所有手术的术后 CSF 漏风险为 4.8%，大的颅底骨缺损手术的风险为 9.1%，如果采用密封垫闭合则为 0%。2 例患者使用了鼻中隔黏膜瓣。1 例患者术后发生了梗死，1 例发生深静脉血栓，1 例发生了肺栓塞。平均随访时间为 8.5 个月。所有术前有颅神经功能障碍的患者在末次随访时均有改善。所有患者在末次随访时均无疾病进展。
经鼻内镜颅底切除术为中后颅底腹侧正中提供了一种微创入路。如果采用合适的闭合技术，CSF 漏的风险较低。
