Culebras Diego, Torales Jorge, Reyes Luis Alberto, Zapata Luis, García Sergio, Roldán Pedro, Langdon Cristóbal, Alobid Issam, Enseñat Joaquim
Servicio de Neurocirugía, Unidad de Cirugía de Base de Cráneo, Hospital Clínic, Barcelona, España.
Servicio de Neurocirugía, Unidad de Cirugía de Base de Cráneo, Hospital Clínic, Barcelona, España.
Neurocirugia (Engl Ed). 2018 Jul-Aug;29(4):201-208. doi: 10.1016/j.neucir.2018.03.004. Epub 2018 Apr 22.
To report our experience in the management of chordoma and chondrosarcoma with extended endoscopic endonasal surgery.
We performed a retrospective analysis of a series of 14 patients with clival chordoma or chondrosarcoma who had extended endoscopic endonasal surgery from 2008 to 2016 performed by the same multidisciplinary team.
We had fourteen patients (male/female 2:1), with a mean age of 49years for chordoma and 32 for chondrosarcoma. The most common clinical presentation was diplopia in 78.5% of cases, followed by dysphagia in 28.6%. Histologically, 71.4% were chordomas and 28.6% were chondrosarcomas. In addition, invasion of at least two thirds or more of the clivus was found in 81% of the cases; in 57.1% there was intradural invasion, and in 35.7% invasion of the sella turcica. In 42.8% of cases, the degree of resection was total and in 21.5% subtotal. The most common complication was CSF fistula, occurring in 28.6% of the cases, with only one case requiring surgery to repair it. Adjuvant treatment with Proton Beam was performed in 35.7% of cases and with conventional radiotherapy in 21.5%. Mean follow-up was 53.5months and tumour recurrence or progression was found in 21.5% of the cases, two of which had not received adjuvant treatment. There were no deaths.
The extended endoscopic endonasal approach (EEEA) performed by an experienced team is a good alternative for the management of these lesions. Intradural invasion may be related to an increased risk of complications and worse clinical presentation, in addition to a lower rate of total resection.
报告我们采用扩大经鼻内镜手术治疗脊索瘤和软骨肉瘤的经验。
我们对2008年至2016年由同一多学科团队进行扩大经鼻内镜手术的14例斜坡脊索瘤或软骨肉瘤患者进行了回顾性分析。
我们有14例患者（男/女为2:1），脊索瘤患者的平均年龄为49岁，软骨肉瘤患者为32岁。最常见的临床表现是78.5%的病例出现复视，其次是28.6%的病例出现吞咽困难。组织学上，71.4%为脊索瘤，28.6%为软骨肉瘤。此外，81%的病例发现斜坡至少三分之二或更多被侵犯；57.1%有硬膜内侵犯，35.7%侵犯蝶鞍。42.8%的病例切除程度为全切，21.5%为次全切。最常见的并发症是脑脊液漏，发生在28.6%的病例中，只有1例需要手术修复。35.7%的病例接受了质子束辅助治疗，21.5%接受了传统放疗。平均随访53.5个月，21.5%的病例发现肿瘤复发或进展，其中2例未接受辅助治疗。无死亡病例。
由经验丰富的团队实施的扩大经鼻内镜入路（EEEA）是治疗这些病变的一种良好选择。硬膜内侵犯除了全切率较低外，可能还与并发症风险增加和临床表现较差有关。
