Maira G, Pallini R, Anile C, Fernandez E, Salvinelli F, La Rocca L M, Rossi G F
Department of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
J Neurosurg. 1996 Nov;85(5):784-92. doi: 10.3171/jns.1996.85.5.0784.
This is a report of 12 cases of clival chordomas that were surgically treated at the Catholic University Medical School, Rome, Italy, over a 7-year period. The study emphasizes the role of the transsphenoidal approach. The study group included seven men and five women whose ages ranged from 26 to 80 years (mean 49.8 years). Diplopia was the most common presenting symptom (eight cases). The tumor involved the upper and middle clivus in five cases, the middle clivus in five, and the lower clivus in two cases. One patient developed spinal metastasis. On histological examination, eight cases proved to be typical chordomas, three cases had a chondroid component, and one case of chordoma had atypical features. Immunohistological staining for vimentin and epithelial membrane antigen was positive in all cases. Follow-up periods ranged from 14 to 86 months (mean 40.2 months). The primary treatment consisted of surgery. Ten patients with chordomas of the upper and middle clivus underwent a total of 13 transsphenoidal procedures. Total tumor removal was achieved in seven cases, subtotal removal in two, and partial removal in one case. In the two cases of lower clival chordomas, total removal was accomplished in one and partial removal in the other. After total removal, no recurrence was noted at 14 to 86 months (mean 37.5 months). In the cases undergoing operation via a transsphenoidal approach, there was zero morbidity and one cerebrospinal fluid fistula that resolved without surgery. The tumor recurred in two patients after subtotal and partial removal, respectively. The authors opted to reoperate in cases of recurrence. Postoperative radiotherapy was administered in only two cases in which further surgery was not indicated because of medical reasons or because such a procedure was contrary to the patient's wishes. When mortality and morbidity rates of this group are compared to those of chordoma patients who were treated with extensive skull-base surgery, the results prompt a reappraisal of the transsphenoidal approach in the treatment of clival chordomas.
这是一篇关于12例斜坡脊索瘤的报告，这些病例是在意大利罗马天主教大学医学院7年期间接受手术治疗的。该研究强调了经蝶窦入路的作用。研究组包括7名男性和5名女性，年龄在26至80岁之间（平均49.8岁）。复视是最常见的首发症状（8例）。肿瘤累及上斜坡和中斜坡5例，中斜坡5例，下斜坡2例。1例患者发生脊柱转移。组织学检查显示，8例为典型脊索瘤，3例有软骨样成分，1例脊索瘤有非典型特征。所有病例波形蛋白和上皮膜抗原免疫组织化学染色均为阳性。随访时间为14至86个月（平均40.2个月）。主要治疗方法为手术。10例上斜坡和中斜坡脊索瘤患者共接受了13次经蝶窦手术。7例实现了肿瘤全切，2例次全切，1例部分切除。2例下斜坡脊索瘤中，1例全切，另1例部分切除。全切后，14至86个月（平均37.5个月）未发现复发。在经蝶窦入路手术的病例中，无手术相关并发症发生，1例脑脊液漏未经手术自行愈合。次全切和部分切除的2例患者肿瘤分别复发。作者选择在复发时再次手术。仅2例因医学原因或因该手术与患者意愿相悖而未行进一步手术的患者接受了术后放疗。当将该组的死亡率和发病率与接受广泛颅底手术治疗的脊索瘤患者的死亡率和发病率进行比较时，结果促使人们重新评估经蝶窦入路在斜坡脊索瘤治疗中的应用。
