Zhang Ya-Zhuo, Wang Zong-Cheng, Zong Xu-Yi, Wang Xin-Sheng, Gui Song-Bai, Zhao Peng, Li Chu-Zhong, He Yue, Wang Hong-Yun
Beijing Neurosurgical Institute, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
Zhonghua Yi Xue Za Zhi. 2011 Jul 5;91(25):1734-8.
To further explore the application, approach, indication and prognosis of neuroendoscope treatment for skull base chordoma.
A total of 101 patients of skull base chordoma were admitted at our hospital from May 2000 to April 2010. There were 59 males and 42 females. Their major clinical manifestations included headache, cranial nerve damage and dyspnea. They were classified according to the patterns of tumor growth: Type I (n = 13): tumor location at a single component of skull base, i. e. clivus or sphenoid sinus with intact cranial dura; Type II (n = 56): tumor involving more than two components of skull e. g clivus, sphenoid and nasal/oral cavity, etc. But there was no intracranial invasion; Type III (n = 32) : tumor extending widely and intradurally forming compression of brain stems and multiple cranial nerves. Based on the types of chordoma, different endoscopic approaches were employed, viz. transnasal, transoral, trans-subtemporal fossa and plus microsurgical craniotomy for staging in some complex cases.
Among all patients, total resection was achieved (n = 19), subtotal (n = 58) and partial (n = 24). In partial resection cases, 16 cases were considered to be subtotal due to a second-stage operation. Most cases had conspicuous clinical improvements. Self-care recovery within one week post-operation accounted for 58.4%, two weeks 30.7%, one month 6.9% and more than one month 1.9%. Postoperative complications occurred in 13 cases (12.8%) and included CSF leakage (n = 4) cranial nerve palsy (n = 5), hemorrhagic nasal wounds (n = 3) and delayed intracranial hemorrhage (n = 1). All of these were cured or improved after an appropriate treatment. A follow-up of 6 - 60 months was conducted in 56 cases.
Early detection and early treatment are crucial for achieving a better outcome in chordoma. Neuroendoscopic treatment plays an important role in managing those complicated cases. Precise endoscopic techniques plus different surgical approaches and staging procedures are required to improve the post-operative quality of life for patients.
进一步探讨神经内镜治疗颅底脊索瘤的应用、方法、适应证及预后。
2000年5月至2010年4月我院共收治101例颅底脊索瘤患者。其中男性59例，女性42例。主要临床表现为头痛、脑神经损害及呼吸困难。根据肿瘤生长方式分类：Ⅰ型（n = 13）：肿瘤位于颅底单一结构，即斜坡或蝶窦，硬脑膜完整；Ⅱ型（n = 56）：肿瘤累及颅底两个以上结构，如斜坡、蝶骨及鼻腔/口腔等，但无颅内侵犯；Ⅲ型（n = 32）：肿瘤广泛扩展并经硬膜内生长，压迫脑干及多条脑神经。根据脊索瘤类型，采用不同的内镜入路，即经鼻、经口、经颞下窝，部分复杂病例加用显微开颅分期手术。
所有患者中，实现全切除（n = 19）、次全切除（n = 58）和部分切除（n = 24）。在部分切除病例中，16例因二期手术被认为是次全切除。大多数病例临床改善明显。术后1周内自理恢复占58.4%，2周占30.7%，1个月占6.9%，1个月以上占1.9%。术后并发症发生13例（12.8%），包括脑脊液漏（n = 4）、脑神经麻痹（n = 5）、鼻伤口出血（n = 3）和迟发性颅内出血（n = 1）。经适当治疗后均治愈或好转。对56例患者进行了6至60个月的随访。
早期发现和早期治疗对脊索瘤取得更好疗效至关重要。神经内镜治疗在处理这些复杂病例中发挥重要作用。需要精确的内镜技术加上不同的手术入路和分期程序来提高患者术后生活质量。
