Department of Neurosurgery, Baylor College of Medicine.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Oper Neurosurg (Hagerstown). 2017 Aug 1;13(4):421-434. doi: 10.1093/ons/opx020.
Microsurgical resection via open approaches is considered the main treatment modality for cranial base chondrosarcomas (CBCs). The use of endoscopic endonasal approaches (EEAs) has been rarely reported.
To present the endoscopic endonasal experience with CBCs at our institution.
Retrospective review of the medical records of 35 consecutive patients who underwent EEA for CBC resection between January 2004 and April 2013. Surgical outcomes and variables that might affect extent of resection, complications, and recurrence were analyzed.
Forty-eight operations were performed (42 EEAs and 6 open approaches). Gross-total resection was achieved in 22 patients (62.9%), near total (≥90% tumor resection) in 11 (31.4%). Larger tumors were associated with incomplete resection in univariate and multivariate analysis ( P = .004, .015, respectively). In univariate analysis, tumors involving the lower clivus and cerebellopontine angle were associated with increased number of complications, especially postoperative cerebrospinal fluid leak ( P = .015) and new cranial neuropathy ( P = .037), respectively. Other major complications included 2 cases of meningitis and deep venous thrombosis, and 1 case of hydrocephalus and carotid injury. Involvement of the lower clivus, parapharyngeal space, and cervical spine required a combination of approaches to maximize tumor resection ( P = .017, .044, .017, respectively). No predictors were significantly associated with increased risk of recurrence. The average follow-up time was 44.6 ± 31 months.
EEAs may be considered a good option for managing CBCs without significant posterolateral extension beyond the basal foramina and can be used in conjunction with open approaches for maximal resection with acceptable morbidity.
经颅底开放入路的显微切除术被认为是颅底软骨肉瘤（CBCs）的主要治疗方式。内镜经鼻入路（EEAs）的应用很少有报道。
介绍我们机构内镜经鼻入路治疗颅底软骨肉瘤的经验。
回顾性分析 2004 年 1 月至 2013 年 4 月期间，35 例连续接受 EEA 切除颅底软骨肉瘤的患者的病历。分析手术结果和可能影响切除程度、并发症和复发的变量。
共进行了 48 次手术（42 次 EEA 和 6 次开放手术）。22 例（62.9%）患者实现了全切除，11 例（31.4%）患者实现了近全切除（≥90%肿瘤切除）。在单因素和多因素分析中，较大的肿瘤与不完全切除相关（P=0.004，0.015）。在单因素分析中，累及颅底下部和桥小脑角的肿瘤与并发症发生率增加相关，尤其是术后脑脊液漏（P=0.015）和新的颅神经病变（P=0.037）。其他主要并发症包括 2 例脑膜炎和深静脉血栓形成，1 例脑积水和颈动脉损伤。累及颅底下部、咽旁间隙和颈椎需要联合应用多种方法，以最大限度地切除肿瘤（P=0.017，0.044，0.017）。没有预测因素与复发风险增加显著相关。平均随访时间为 44.6±31 个月。
EEAs 可能是一种治疗没有明显向基底孔以外的后外侧扩展的颅底软骨肉瘤的良好选择，并且可以与开放手术联合使用，以获得可接受的发病率的最大切除程度。
