Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Acta Neurochir (Wien). 2012 May;154(5):879-86. doi: 10.1007/s00701-012-1317-1. Epub 2012 Mar 9.
The surgical approaches for clival chordomas remain controversial, although the extent of resection is one of the most important factors for long survival rates. Recently an endoscopic endonasal approach in good collaboration with otolaryngologists has attracted major attention as a surgical approach for clival chordomas. We describe our experience with the endoscopic endonasal approach and provide a review of the literature.
Between 2008 and 2011, six operations were performed via the endoscopic endonasal approach for clivus chordomas. The mean tumor size was 35 mm in diameter. The tumor location was mainly from the upper to middle clivus. The tumor extended into the cavernous sinus in five cases and intradurally in three cases. A binostril approach was performed in four cases, while a one nostril approach was performed in two cases.
Gross total removal was achieved in three cases. The analysis of cases with incomplete resection suggested that residual tumors were observed epidurally and subdurally. The residual on the epidura was observed from the posterior clinoid to the posterior compartment of the cavernous sinus. On the other hand, the residual on the subdural was observed behind the upper part of the pituitary gland. There was no postoperative cerebrospinal fluid (CSF) leakage using vascularized nasoseptal flaps in any of the cases.
The endoscopic endonasal transclival approach allows an appropriate extent of resection with acceptable complication rates in comparison with other approaches. In our series, the accomplishment of gross total removal was associated with the relationship between the tumors and surrounding structures, such as the pituitary gland and the cavernous portion of the intracranial carotid artery (ICA).
尽管切除范围是提高长期生存率的最重要因素之一，但对于颅底脊索瘤的手术入路仍存在争议。最近，内镜经鼻入路与耳鼻喉科医生的良好合作已引起广泛关注，成为治疗颅底脊索瘤的一种手术方法。我们描述了我们使用内镜经鼻入路的经验，并对文献进行了回顾。
2008 年至 2011 年期间，我们通过内镜经鼻入路对 6 例颅底脊索瘤患者进行了手术。肿瘤平均直径为 35 毫米。肿瘤部位主要位于颅底中上段。5 例肿瘤向海绵窦内延伸，3 例肿瘤向颅内延伸。4 例采用双鼻孔入路，2 例采用单鼻孔入路。
3 例获得大体全切除。对不完全切除病例的分析表明，残留肿瘤位于硬膜外和硬膜下。硬膜外的残留在蝶骨嵴后至海绵窦后腔。另一方面，硬膜下的残留位于垂体上部的后面。使用带血管鼻中隔瓣，所有病例均无术后脑脊液（CSF）漏。
与其他入路相比，内镜经鼻颅底入路可在获得适当切除范围的同时，降低并发症发生率。在我们的系列中，大体全切除的实现与肿瘤与周围结构（如垂体和颈内动脉颅内段）之间的关系有关。
