Wang Xin, Li Long, Wang Yibao, Hu Jinqu, Zhou Jinpeng, Jing Zhitao, Wu Anhua
Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Shenyang, China.
J Craniofac Surg. 2017 Sep;28(6):e554-e557. doi: 10.1097/SCS.0000000000003859.
Skull base chordoma is a rare tumor arising from embryonic remnants of the notochord with invasive potential. Due to the destruction of osseous landmarks and invasion of surrounding structures, surgical resection is challenging. The authors explored the clinical value of a multimodal neuronavigation system in skull base chordoma resection using a neuroendoscope. Between January 2012 and January 2016, the authors utilized neuroendoscopy to excise skull base chordoma in 93 patients. The authors performed 45 operations assisted by multimodal neuronavigation (neuronavigation group) and 48 without intraoperative imaging guidance (control group). In the control group, 35 patients (73%) underwent gross total resection. In the neuronavigation group, all patients underwent gross total resection without radiographically identified bleeding. Only 1 patient (2%) in the neuronavigation group showed a temporary reduction in vision, which improved after symptomatic treatment. In contrast, there were 4 patients (8%) with postoperative complication, including 2 patients with intracranial hematoma and 2 with neurological deficits. Complication rates were higher than the neuronavigation group. In the follow-up period, 2 patients in the control group with subtotal resection had recurrence within 24 months, but without extracranial metastases. The multimodal neuronavigation system could contribute intraoperative real-time guidance for spatial relationships between lesions and adjacent neurovascular structures, as well as eroded and distorted anatomical landmarks through multiple image fusion and 3-dimensional reconstruction. It significantly improves surgical outcome and provides a new insight into the management of skull base chordomas.
颅底脊索瘤是一种起源于脊索胚胎残余组织的罕见肿瘤，具有侵袭性。由于骨性标志的破坏和周围结构的侵犯，手术切除具有挑战性。作者探讨了多模态神经导航系统在使用神经内镜切除颅底脊索瘤中的临床价值。在2012年1月至2016年1月期间，作者利用神经内镜为93例患者切除颅底脊索瘤。作者进行了45例多模态神经导航辅助手术（神经导航组）和48例无术中影像引导的手术（对照组）。在对照组中，35例患者（73%）实现了全切。在神经导航组中，所有患者均实现了全切，且影像学检查未发现出血。神经导航组中只有1例患者（2%）出现视力暂时下降，经对症治疗后有所改善。相比之下，对照组有4例患者（8%）出现术后并发症，包括2例颅内血肿和2例神经功能缺损。并发症发生率高于神经导航组。在随访期间，对照组中2例次全切的患者在24个月内复发，但无颅外转移。多模态神经导航系统可通过多图像融合和三维重建为病变与相邻神经血管结构之间的空间关系以及被侵蚀和扭曲的解剖标志提供术中实时引导。它显著改善了手术效果，并为颅底脊索瘤的治疗提供了新的思路。
