Department of Otolaryngology, St. Louis University Hospital, St. Louis, MO.
Int Forum Allergy Rhinol. 2015 Apr;5(4):344-52. doi: 10.1002/alr.21457. Epub 2014 Dec 22.
The objective of this work was to report success rates as well as potential obstacles in transnasal endoscopic resection of anterior skull base meningiomas.
The study design was a case series with chart review at tertiary referral centers in South Australia and New Zealand. The patients were 37 consecutive patients who underwent endoscopic resection of skull-base meningiomas between 2004 and 2013. Review of patient charts and operative details were performed. Outcomes including complications are reported.
Eighty-four percent of patients were women. There were 28 primary and 9 revision cases. Tumor locations were as follows: 14 olfactory groove/subfrontal; 12 planum/jugum sphenoidale; 7 tuberculum sellae; 3 clinoidal; and 1 clival. Vision change was the most common presenting symptom. Mean tumor volume was 33.68 cm(3) , mean diameter was 2.78 cm. Average operating times decreased with an initial learning curve and then plateaued. Primary tumors larger than 60 cm(3) took an average of 10 hours to resect. Gross total removal was achieved in 29 patients. There were no perioperative deaths. Two deaths occurred within 1 year of surgery. Postoperative cerebrospinal fluid (CSF) leaks occurred in 13 patients. Seventy-five percent of patients presenting with visual loss reported visual improvement. Of the 29 patients considered to have had complete resection at surgery, one was found to have residual disease on a postoperative magnetic resonance imaging (MRI) and another one later developed radiological evidence of recurrence.
Using a 2-team approach, meningiomas of the skull base were successfully removed via an intranasal endoscopic technique. Although complete resection is typically possible even with large tumors, the lengthy resection required time for tumors larger than 60 cm(3) (diameter ≥4 cm) may obviate some of the advantages of this approach. The rate of postoperative CSF leak decreases when a synthetic dural substitute is added but does not approach zero.
本研究旨在报告经鼻内镜颅底前颅窝脑膜瘤切除术的成功率和潜在障碍。
这是一项在澳大利亚南部和新西兰的三级转诊中心进行的病例系列和图表回顾研究。纳入 2004 年至 2013 年间接受内镜下颅底脑膜瘤切除术的 37 例连续患者。回顾患者病历和手术细节。报告包括并发症在内的结果。
84%的患者为女性。原发性病例 28 例，复发性病例 9 例。肿瘤部位如下：14 例嗅沟/额下；12 例蝶骨平台/鞍结节；7 例鞍结节；3 例岩骨尖；1 例斜坡。视力改变是最常见的首发症状。肿瘤平均体积为 33.68cm3，平均直径为 2.78cm。平均手术时间随着初始学习曲线而减少，然后趋于平稳。体积大于 60cm3 的原发性肿瘤平均需要 10 小时才能切除。29 例患者达到大体全切除。无围手术期死亡。2 例患者在术后 1 年内死亡。术后发生脑脊液（CSF）漏 13 例。29 例术中认为完全切除的患者中，1 例术后磁共振成像（MRI）发现残留病变，另 1 例术后影像学显示复发。
采用 2 人团队方法，经鼻内镜成功切除颅底脑膜瘤。尽管即使肿瘤较大也通常可以实现完全切除，但对于直径大于 4cm 的大于 60cm3 的肿瘤，较长的切除时间可能会使该方法的一些优势不复存在。当使用合成硬脑膜替代物时，术后 CSF 漏的发生率会降低，但仍无法降至零。
