Hayhurst Caroline, Sughrue Michael E, Gore Pankaj A, Bonney Phillip A, Burks Joshua D, Teo Charles
University Hospital of Wales, Department of Neurosurgery, Cardiff, United Kingdom.
Turk Neurosurg. 2016;26(5):662-70. doi: 10.5137/1019-5149.JTN.16105-15.3.
Reconstruction technique advances have created renewed enthusiasm for the expanded endonasal approach (EEA). However, as with any new technique, early experiences inevitably lead to more selective use of these techniques. We reviewed our experience of the expanded endonasal endoscopic approach for skull base meningiomas and place it in context of the literature.
We performed retrospective review of all endonasal cases performed at our center for histologically proven meningioma. Tumor locations in 26 patients included the olfactory groove (n=9), tuberculum sellae (n=7), optic nerve sheath (n=1), planum sphenoidale (n=2), clival (n=1) petroclival (n=3), cavernous sinus (n=2) and extensive pan-basal meningioma (n=1).
The median follow-up was 38.6 months. Excluding 3 patients with tumors found incidentally, pre-operative symptoms improved in 14 of 23 (61%), were the same in 8 of 23 (35%) and worsened in one of 23 patients (4%) at time of last follow-up. Of all 26 patients, 16 (62%) had complete macroscopic resection of their tumor, 5 (19%) underwent at least 90% resection, and 5 (19%) underwent subtotal resection. There were two neurological complications and one cerebrospinal fluid leak.
This study presents outcomes of patients treated with endonasal endoscopic meningioma surgery. We believe that very low rates of morbidity can be achieved in carefully selected patients, thus avoiding brain manipulation.
重建技术的进步使人们对扩大经鼻入路（EEA）重新燃起热情。然而，与任何新技术一样，早期经验不可避免地导致这些技术的使用更加有选择性。我们回顾了我们采用扩大经鼻内镜入路治疗颅底脑膜瘤的经验，并将其与文献情况相结合。
我们对在我们中心进行的所有经组织学证实为脑膜瘤的鼻内手术病例进行了回顾性研究。26例患者的肿瘤位置包括嗅沟（n = 9）、鞍结节（n = 7）、视神经鞘（n = 1）、蝶骨平台（n = 2）、斜坡（n = 1）、岩斜区（n = 3）、海绵窦（n = 2）和广泛的全基底脑膜瘤（n = 1）。
中位随访时间为38.6个月。排除3例偶然发现肿瘤的患者，在最后一次随访时，23例中有14例（61%）术前症状改善，23例中有8例（35%）症状相同，23例中有1例（4%）症状恶化。在所有26例患者中，16例（62%）实现了肿瘤的肉眼全切，5例（19%）至少切除了90%，5例（19%）进行了次全切除。有2例神经并发症和1例脑脊液漏。
本研究展示了经鼻内镜脑膜瘤手术治疗患者的结果。我们认为，在精心挑选的患者中可以实现非常低的发病率，从而避免脑部操作。
