Zhang Qiu-hang, Kong Feng, Guo Hong-chuan, Chen Ge
Skull Base Surgery Center, Department of Otorhinolaryngology Head and Neck Surgery, Capital Medical University Xuanwu Hospital, Beijing 100053, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2010 Jul;45(7):542-6.
Clival chordoma with intradural extension is very difficult to manage mont. Primary experience of nasal endoscopic surgery for the extra-intra clival chordomas was reported.
Between 2007 and 2009, 7 patients (4 males and 3 females, ages ranging from 8 to 62 years) with clival extra-intra dural chordoma underwent nasal endoscopic surgeries, 4 of them with combined transoral approach. Charts were reviewed for clinical characteristics, previous therapies, tumor extent, management modalities, complications, and outcome.
Total resection of tumor was obtained in 6 cases and subtotal resection in one case. Postoperative follow-up period ranged from 3 to 25 months, median 22 months. One of 6 cases with total resection was recurrent and alive with disease. The patient with subtotal resection died secondary to progression of disease 10 months after the surgery. There was no intraoperative complication. Expect for one case of transient cerebral spinal fluid leakage, no postoperative complication was encountered.
Nasal endoscopic approach may provide a less invasive surgery for clival chordoma with intradural extension. It is safe and effective when it is performed by the surgeons with adequate experience and skills and perioperative managements were taken.
处理累及硬膜内的斜坡脊索瘤极具挑战性。本文报道了鼻内镜手术治疗斜坡内外脊索瘤的初步经验。
2007年至2009年间，7例（4例男性，3例女性，年龄8至62岁）斜坡硬膜内外脊索瘤患者接受了鼻内镜手术，其中4例联合经口入路。回顾病历以了解临床特征、既往治疗情况、肿瘤范围、治疗方式、并发症及预后。
6例实现肿瘤全切，1例次全切除。术后随访时间为3至25个月，中位时间22个月。6例全切患者中有1例复发且带瘤生存。次全切除患者术后10个月因疾病进展死亡。术中无并发症。除1例短暂性脑脊液漏外，未出现术后并发症。
鼻内镜入路可为累及硬膜内的斜坡脊索瘤提供一种侵入性较小的手术方式。由经验丰富、技术娴熟的外科医生实施并进行围手术期管理时，该方法安全有效。
