Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
Department of Neurosurgery, Faculty of Medicine, University of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
Sci Rep. 2023 Feb 21;13(1):3012. doi: 10.1038/s41598-023-30216-8.
Clival tumors present challenging entities regarding their treatment options. Due to their proximity to critical neurovascular structures, the operative goal of gross total tumor resection is rendered more difficult by a high risk of neurological deficits. Retrospective cohort study of patients treated for clival neoplasms through a transnasal endoscopic approach between 2009 and 2020. Assessment of preoperative clinical status, length of operation, number of approaches, pre- and postoperative radiotherapy, and the clinical outcome. Presentation and clinical correlation with our new classification. In total, 59 transnasal endoscopic operations were performed on 42 patients over 12 years. Most lesions were clival chordomas; 63% of the lesions did not reach the brainstem. Cranial nerve impairment was present in 67% of the patients, and 75% of the patients with cranial nerve palsy improved after surgical treatment. Interrater reliability for our proposed tumor extension classification showed a substantial agreement (Cohen's κ = 0.766). The transnasal approach was sufficient to achieve a complete tumor resection in 74% of the patients. Clival tumors exhibit heterogeneous characteristics. Depending on clival tumor extension, the transnasal endoscopic approach can present a safe surgical technique for upper and middle clival tumor resection, with a low risk of perioperative complications and a high rate of postoperative improvement.
颅底肿瘤在治疗选择方面具有挑战性。由于其靠近关键的神经血管结构，因此，在高神经功能缺损风险的情况下，实现大体全切除肿瘤的手术目标变得更加困难。对 2009 年至 2020 年间通过经鼻内镜入路治疗颅底肿瘤的患者进行回顾性队列研究。评估术前临床状况、手术时间、入路次数、术前和术后放疗以及临床结果。介绍并与我们新的分类进行临床相关性分析。在 12 年期间，共对 42 名患者进行了 59 次经鼻内镜手术。大多数病变为颅底脊索瘤；63%的病变未到达脑干。67%的患者存在颅神经损伤，75%的颅神经麻痹患者在手术后得到改善。我们提出的肿瘤扩展分类的组内相关系数显示出高度一致性（Cohen's κ=0.766）。经鼻入路足以使 74%的患者实现完全肿瘤切除。颅底肿瘤表现出异质性特征。根据颅底肿瘤的扩展情况，经鼻内镜入路可为中上颅底肿瘤切除术提供一种安全的手术技术，具有较低的围手术期并发症风险和较高的术后改善率。
