Yousaf Jawad, Afshari Fardad T, Ahmed Shahzada K, Chavda Swarupsinh V, Sanghera Paul, Paluzzi Alessandro
a Department of Neurosurgery, Birmingham University Hospital , Birmingham , England.
b Department of ENT, Birmingham University Hospital , Birmingham , England.
Br J Neurosurg. 2019 Aug;33(4):388-393. doi: 10.1080/02688697.2019.1567683. Epub 2019 Feb 11.
Clival Chordomas are locally aggressive tumours which pose a significant treatment challenge. Endoscopic endonasal approach for clival chordomas is correlated with higher resection rates and lower morbidity rates in comparison to open approaches. We present our initial single institution experience and short-term patient outcomes following endoscopic endonasal approach for resection of clival chordomas. This is a retrospective analysis of ten patients undergoing endoscopic endonasal approach for clival chordomas in our neurosurgical unit over a 6 year period between August 2010 and September 2016. The procedures were performed using two surgeons, four hands, binostril endoscopic endonasal approach with a Karl Storz endoscope and intraoperative BrainLab image guidance. Overall 15 endoscopic endonasal approach resections of clival chordoma were performed in 10 patients with median follow up period of 39.5 months (range 9-76). Gross total resection was achieved in 4 cases (40%), near total resection in 4 cases (40%) and subtotal resection in 2 cases (20%). 5 cases (50%) required revision resections. Cerebrospinal fluid leak occurred in 2 patients. 1 case of meningitis occurred in a patient with revision surgery. There were no new neurological deficits post operatively with 3 patients demonstrating resolution of diplopia post operatively. No recurrence occurred following gross total resection. 1 out of 4 cases of near total resection showed evidence of progression during the follow up period. Both cases of subtotal resection demonstrated evidence of progression with one dying of unrelated cause during the follow up period. Endoscopic endonasal approach represents a safe technique for debulking and resection of clival chordomas. Due to the rarity of clival chordomas, it is important that patients with this pathology are managed in high volume skull base centres where a multi-disciplinary team approach is available.
斜坡脊索瘤是具有局部侵袭性的肿瘤，对治疗构成重大挑战。与开放手术相比，内镜下经鼻入路治疗斜坡脊索瘤的切除率更高，发病率更低。我们介绍了我们在单一机构采用内镜下经鼻入路切除斜坡脊索瘤的初步经验和短期患者预后情况。这是一项对2010年8月至2016年9月期间在我们神经外科接受内镜下经鼻入路治疗斜坡脊索瘤的10例患者的回顾性分析。手术由两名外科医生采用四手操作，经双侧鼻孔的内镜下经鼻入路，使用卡尔·史托斯内镜和术中BrainLab图像引导。10例患者共进行了15次内镜下经鼻入路切除斜坡脊索瘤手术，中位随访期为39.5个月（9 - 76个月）。4例（40%）实现了全切除，4例（40%）接近全切除，2例（20%）次全切除。5例（50%）需要再次切除。2例患者发生脑脊液漏。1例患者在再次手术时发生脑膜炎。术后无新的神经功能缺损，3例患者术后复视症状消失。全切除后无复发。4例接近全切除的病例中有1例在随访期间出现进展迹象。2例次全切除病例均出现进展迹象，其中1例在随访期间死于无关原因。内镜下经鼻入路是一种安全有效的减少肿瘤体积和切除斜坡脊索瘤的技术。由于斜坡脊索瘤罕见, 因此，在能够提供多学科团队治疗的大型颅底中心对患有这种疾病的患者进行治疗非常重要。
