ENDOSCOPIC ENDONASAL RESECTION OF ANTERIOR CRANIAL BASE MENINGIOMAS
ENDOSCOPIC ENDONASAL RESECTION OF ANTERIOR CRANIAL BASE MENINGIOMAS
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DOI：
10.1227/01.neu.0000316852.01820.45
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发表时间：
2008-07
期刊：
影响因子：
4.8
通讯作者：
P. Gardner;A. Kassam;A. Thomas;C. Snyderman;R. Carrau;A. Mintz;D. Prevedello
中科院分区：
文献类型：
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作者：
P. Gardner;A. Kassam;A. Thomas;C. Snyderman;R. Carrau;A. Mintz;D. Prevedello
经鼻入路切除毗邻鼻窦的前颅底肿瘤是可行的。有几个病例报告和混合病例系列讨论了这种方法。除垂体腺瘤外，缺乏文献描述经鼻入路治疗脑膜瘤等单一肿瘤类型的结局。方法在这项研究中，我们描述了我们目前的内窥镜经鼻技术，并证明了使用它从额窦后壁到鞍和眶中部区域的外侧进入前颅底脑膜瘤的可行性。在此讨论之后，包括关键的技术考虑和细微差别，我们通过报告35例前颅底脑膜瘤内镜经鼻切除术的早期经验的结果来讨论安全性和有效性。从2002年10月至2005年10月，共有35例患者接受了内窥镜下经鼻切除前颅底脑膜瘤。根据肿瘤位置的切除程度如下：12例计划完全切除的嗅沟脑膜瘤患者中有10例（83%）进行了大体全切除，（12人中有7人）或接近全部（>95%）（3/12）切除术13例结节脑膜瘤中有12例（92%）进行了大体检查，（11/13）或接近（>95%）（1/13）全切除; 5例诊断为岩斜脑膜瘤的患者成功切除了肿瘤的鞍旁部分，缓解了视觉症状（没有患者通过内窥镜鼻内入路完全切除肿瘤）;两个巨大岩斜脑膜瘤分别切除63%和89%，所有患者的视觉症状均得到缓解或改善。没有患者在手术后出现永久性视力恶化。只有1例（3%）术前无内分泌功能障碍的患者发生了新的永久性垂体功能缺损，尿崩症。1例（3%）患者在术后3周出血后出现新发神经功能缺损。术后脑脊液漏率为40%（14/35），并因肿瘤部位而异。所有泄漏均在未进行开颅手术的情况下得到解决。无细菌性脑膜炎病例。1例患者术后2年发生鼻窦炎无菌性肉芽肿双重感染。有两例深静脉血栓形成和一例肺栓塞。无手术或围手术期死亡。结论：颅底脑膜瘤可以通过单纯内镜经鼻入路成功治疗，并发症和死亡率可接受。切除的范围由患者因素和症状决定，而不是由手术入路决定。该系列的脑脊液漏发生率较高。随着新的重建技术的发展，这些比率已大大降低。
OBJECTIVEThe endonasal route may be feasible for the resection of anterior cranial base tumors that abut the paranasal sinuses. There are several case reports and mixed case series discussing this approach. Other than pituitary adenomas, there is a lack of literature describing the outcomes of endonasal approaches for single-tumor types such as meningiomas. METHODSIn this study, we describe our current endoscopic endonasal technique and demonstrate the feasibility of using it to access anterior cranial base meningiomas from the back wall of the frontal sinus to the sella and laterally to the region of the midorbit. After this discussion, which includes key technical considerations and nuances, we address safety and efficacy by reporting the outcomes of our early experience with endoscopic endonasal resection of 35 anterior cranial base meningiomas. RESULTSA total of 35 patients underwent endoscopic endonasal resection of anterior cranial base meningiomas from October 2002 to October 2005. Degree of resection by tumor location was as follows: 10 of the 12 (83%) patients with olfactory groove meningiomas planned for complete resection underwent gross total (seven of 12) or near-total (>95%) (three of 12) resection (67% of all 15 olfactory tumors); 12 of 13 patients (92%) with tuberculum meningiomas underwent gross (11 of 13) or near (>95%) (one of 13) total resection; five patients diagnosed with petroclival meningiomas had successful resection of the parasellar portion of their tumors with relief of visual symptoms (no patients underwent complete resection of their tumors via the endoscopic, endonasal approach); two giant petroclival meningiomas were debulked with 63 and 89% resection, respectively.All patients experienced resolution or improvement of visual symptoms. No patient experienced permanent worsening of vision after surgery. Only one (3%) patient without preoperative endocrine dysfunction experienced a new, permanent pituitary deficit, diabetes insipidus. One (3%) patient experienced a new neurological deficit after experiencing a hemorrhage 3 weeks after surgery. The postoperative cerebrospinal fluid leak rate was 40% (14 of 35) and varied by tumor location. All leaks were resolved without craniotomy. There were no cases of bacterial meningitis. One patient developed a superinfection of a sterile granuloma from a sinusitis 2 years after surgery. There were two cases of deep venous thrombosis and one pulmonary embolus. There were no operative or perioperative deaths. CONCLUSIONCranial base meningiomas can be successfully managed via a purely endoscopic endonasal approach with acceptable morbidity and mortality rates. The extent of resection is guided by patient factors and symptoms, not by approach. This series had a high cerebrospinal fluid leak rate. With the evolution of new reconstruction techniques, these rates have been substantially reduced.