Chernov I V, Shkarubo A N, Konyashin D A, Andreev D N
Burdenko Neurosurgical Center, Moscow, Russia.
Burdenko Voronezh State Medical University, Voronezh, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2024;88(3):111-119. doi: 10.17116/neiro202488031111.
To date, treatment of chordomas involves maximal tumor resection followed by proton therapy. Various approaches are used depending on location of tumor (transcranial and through natural anatomical openings (nose, mouth), as well as their combinations). Although transoral approach has been introduced into neurosurgical practice for a long time, it is routinely used in patients with chordoma only in certain hospitals in the world.
To analyze postoperative outcomes in patients with chordomas of skull base and craniovertebral joint after transoral surgery.
We analyzed literature data devoted to patients with chordomas of skull base and craniovertebral joint after transoral surgery or another approach combined with transoral access. Among 111 primary articles, we selected 38 manuscripts including description of 109 patients with skull base chordoma who underwent transoral surgery or combination of approaches including transoral one.
Gross total resection was achieved in 45.9% (=50) of cases including 1 patient after en bloc resection. Subtotal resection was carried out in 28.4% of cases, partial - in 24.8%, biopsy - in 0.9% of cases. The complication rate in this group was 30%. The most common events were swelling of the tongue (10%) and diastasis of posterior pharyngeal wall sutures (8.2%) that required redo surgery. CSF leakage and meningitis were rare (1.8% and 3.6%, respectively).
Transoral access allows for gross total resection of midline tumors with low incidence of severe complications. Combination of transoral and transcranial approaches is advisable to increase extent of resection.
迄今为止，脊索瘤的治疗包括最大限度地切除肿瘤，随后进行质子治疗。根据肿瘤位置采用各种方法（经颅和通过自然解剖开口（鼻、口），以及它们的组合）。尽管经口入路已在神经外科实践中应用很长时间，但仅在世界上某些医院常规用于脊索瘤患者。
分析经口手术后颅底和颅颈关节脊索瘤患者的术后结果。
我们分析了有关经口手术或与经口入路联合的其他方法后颅底和颅颈关节脊索瘤患者的文献数据。在111篇主要文章中，我们选择了38篇手稿，其中描述了109例接受经口手术或包括经口入路的联合入路的颅底脊索瘤患者。
45.9%（=50）的病例实现了全切除，其中1例为整块切除后。28.4%的病例进行了次全切除，24.8%为部分切除，0.9%为活检。该组的并发症发生率为30%。最常见的事件是舌肿胀（10%）和咽后壁缝线分离（8.2%），需要再次手术。脑脊液漏和脑膜炎很少见（分别为1.8%和3.6%）。
经口入路可实现中线肿瘤的全切除，严重并发症发生率低。建议联合经口和经颅入路以增加切除范围。
