经鼻内镜颅底脊索瘤切除术的分类及手术入路:161例患者的6年经验
Classification and surgical approaches for transnasal endoscopic skull base chordoma resection: a 6-year experience with 161 cases.
作者信息
Gui Songbai, Zong Xuyi, Wang Xinsheng, Li Chuzhong, Zhao Peng, Cao Lei, Zhang Yazhuo
机构信息
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
出版信息
Neurosurg Rev. 2016 Apr;39(2):321-32; discussion 332-3. doi: 10.1007/s10143-015-0696-1. Epub 2016 Feb 3.
The aim of this study is to retrospectively analyze 161 cases of surgically treated skull base chordoma, so as to summarize the clinical classification of this tumor and the surgical approaches for its treatment via transnasal endoscopic surgery. Between August 2007 and October 2013, a total of 161 patients (92 males and 69 females) undergoing surgical treatment of skull base chordoma were evaluated with regard to the clinical classification, surgical approach, and surgical efficacy. The tumor was located in the midline region of the skull base in 134 cases, and in the midline and paramedian regions in 27 cases (extensive type). Resection was performed via the transnasal endoscopic approach in 124 cases (77%), via the open cranial base approach in 11 cases (6.8%), and via staged resection combined with the transnasal endoscopic approach and open cranial base approach in 26 cases (16.2%). Total resection was achieved in 38 cases (23.6%); subtotal resection, 86 cases (53.4%); partial resection of 80-95%, 29 cases (18%); and partial resection <80%, 8 cases (5%). The clinical classification method used in this study seems suitable for selection of transnasal endoscopic surgical approach which may improve the resection degree and surgical efficacy of skull base chordoma. Gross total resection of skull base chordoma via endoscopic endonasal surgery (with addition of an open approach as needed) is a safe and viable alternative to the traditional open approach.
本研究旨在回顾性分析161例接受手术治疗的颅底脊索瘤病例,以总结该肿瘤的临床分类以及经鼻内镜手术治疗的手术入路。2007年8月至2013年10月期间,对161例接受颅底脊索瘤手术治疗的患者(92例男性,69例女性)进行了临床分类、手术入路及手术疗效评估。肿瘤位于颅底中线区域134例,位于中线及旁中线区域27例(广泛型)。124例(77%)经鼻内镜入路切除,11例(6.8%)经颅底开放入路切除,26例(16.2%)采用分期切除联合经鼻内镜入路和颅底开放入路。全切38例(23.6%);次全切86例(53.4%);部分切除80 - 95%,29例(18%);部分切除<80%,8例(5%)。本研究采用的临床分类方法似乎适合选择经鼻内镜手术入路,这可能提高颅底脊索瘤的切除程度和手术疗效。经鼻内镜手术(必要时加用开放入路)实现颅底脊索瘤的大体全切是传统开放手术安全可行的替代方法。