Kutlay Murat, Durmaz Abdullah, Özer İlker, Kural Cahit, Temiz Çağlar, Kaya Serdar, Solmaz İlker, Daneyemez Mehmet, Izci Yusuf
University of Health Sciences, Gulhane Education and Research Hospital, Department of Neurosurgery, Ankara, Turkey.
University of Health Sciences, Gulhane Education and Research Hospital, Department of Otorhinolaryngology, Ankara, Turkey.
Clin Neurol Neurosurg. 2018 Apr;167:129-140. doi: 10.1016/j.clineuro.2018.02.032. Epub 2018 Feb 21.
With the use of multiple endoscopic endonasal surgical corridors, extended endoscopic endonasal approaches (EEEAs) are now being used to treat a wide range of ventral skull base lesions. Our aim was to present our experience with EEEAs to the ventral skull base lesions.
The study group consisted of 106 patients (57 men and 49 women) who underwent surgery for skull base lesions using EEEAs from 2010 to 2017. The EEEA was most commonly used for giant pituitary macroadenomas, sinonasal malignancies, cerebrospinal fluid (CSF) leaks, meningiomas, craniopharyngiomas, and fibro-osseous lesions. Four different approaches were used including transtuberculum-transplanum, transethmoidal-transcribriform, transclival, and transmaxillary-transpterygoidal.
The overall gross total resection (GTR) rate for these diverse pathologies was 75.0% in 88 patients (excluding the operations performed for non-neoplastic pathologies). GTR was achieved in 100%, 77.8%, 75%, 75%, 72.2%, 62.5%, 60% of fibro-osseous lesions, giant/large pitutary adenomas, meningiomas, esthesioneuroblastomas, sinonasal malignancies, craniopharyngiomas, and chordomas, respectively. The overall rate of improvement in visual fields was 86%. The overall rate of CSF leak was 8.4%. Other surgical complications included intracerebral hematoma and tension pneumocephalus. The mortality rate was 0.9%.
EEEA is a safe, well-tolerated and effective surgical treatment modality in the management of ventral skull base lesions. It should be performed with close interdisciplinary collaboration. Appropriate case selection is mandatory. However, despite improved reconstruction techniques, postoperative CSF leakage still remains a challenge.
随着多种鼻内镜鼻内手术通道的应用，扩大鼻内镜鼻内入路（EEEAs）目前正被用于治疗各种腹侧颅底病变。我们的目的是介绍我们应用EEEAs治疗腹侧颅底病变的经验。
研究组由106例患者（57例男性和49例女性）组成，这些患者在2010年至2017年间接受了使用EEEAs治疗颅底病变的手术。EEEAs最常用于巨大垂体大腺瘤、鼻窦恶性肿瘤、脑脊液（CSF）漏、脑膜瘤、颅咽管瘤和纤维骨性病变。使用了四种不同的入路，包括经结节-经筛板、经筛窦-经筛板、经斜坡和经上颌-经翼突。
在88例患者中（不包括针对非肿瘤性病变进行的手术），这些不同病变的总体全切除（GTR）率为75.0%。纤维骨性病变、巨大/大型垂体腺瘤、脑膜瘤、嗅神经母细胞瘤、鼻窦恶性肿瘤、颅咽管瘤和脊索瘤的GTR率分别为100%、77.8%、75%、75%、72.2%、62.5%、60%。视野改善的总体率为86%。脑脊液漏的总体率为8.4%。其他手术并发症包括脑内血肿和气颅。死亡率为0.9%。
EEEAs是治疗腹侧颅底病变的一种安全、耐受性良好且有效的手术治疗方式。应在密切的多学科协作下进行。必须进行适当的病例选择。然而，尽管重建技术有所改进，但术后脑脊液漏仍然是一个挑战。
