A Comparative Study Between Traditional Microscopic Surgeries and Endoscopic Endonasal Surgery for Skull Base Chordomas
A Comparative Study Between Traditional Microscopic Surgeries and Endoscopic Endonasal Surgery for Skull Base Chordomas
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DOI：
10.1016/j.wneu.2019.11.113
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发表时间：
2020-02-01
影响因子：
2
通讯作者：
Toda, Masahiro
中科院分区：
文献类型：
--
作者：
Oishr, Yumiko;Tamura, Ryota;Toda, Masahiro
背景：颅底脊索瘤（SBC）是临床上罕见的侵袭性肿瘤，手术切除后会出现局部复发。尽管传统上通过开颅手术或显微经蝶手术 (TSS) 切除 SBC，但最近发展的内窥镜经鼻入路 (EEA) 通过微创技术彻底改变了治疗策略。本研究旨在评估传统显微手术或 EEA 治疗 SBC 后的临床结果。 方法：本回顾性研究调查了 1977 年至 2019 年间接受手术的 66 例原发性 SBC 患者。经 EEA 切除 17 例，开颅手术 23 例，经口入路 8 例，TSS 12 例，分期手术 4 例，其他 2 例。中位随访时间为无进展 生存期（PFS）为19.5个月。结果：这些方法术前肿瘤体积或切除率没有显着差异。 EEA 术后脑神经麻痹的发生率明显低于开颅手术（P < 0.05）。尽管4例EEA扩展到斜坡上、下部分均实现全切除，但经口入路或TSS均未实现两部分全切除。这些方法之间未发现 PFS 存在显着差异。多变量分析显示，女性和未接受放疗与较短的 PFS 显着相关（分别为 P < 0.05 和 P < 0.001）。切除率与 PFS 无关。结论：EEA 是一种针对 SBC 的微创手术方法。手术器械和术后放疗的发展将进一步改善患者的治疗效果。
BACKGROUND: Skull base chordomas (SBCs) are rare clinically aggressive neoplasms, developing local recurrences after surgical resection. Although SBCs have traditionally been resected by craniotomy or microscopic transsphenoidal surgery (TSS), the recent development of the endoscopic endonasal approach (EEA) has revolutionized treatment strategies through minimally invasive techniques. This study aimed to evaluate clinical outcomes after traditional microsurgeries or EEAs for SBCs.METHODS: The present retrospective study investigated 66 patients with primary SBCs who underwent surgery between 1977 and 2019. Resection was performed via EEA in 17 cases, craniotomy in 23, transoral approach in 8, TSS in 12, staged surgery in 4, and others in 2. The median follow-up period for progression-free survival (PFS) was 19.5 months.RESULTS: There were no significant differences in preoperative tumor volume or resection rate among these approaches. The incidence of postoperative cranial nerve palsy was significantly lower in EEA than that in craniotomy (P < 0.05). Although total resection was observed in 4 cases of EEA expanding into the superior and inferior part of the clivus, no cases of transoral approach or TSS achieved total resection for both parts. No significant difference in PFS was found among these approaches. Multivariate analysis showed that being female and the absence of radiotherapy were significantly associated with shorter PFS (P < 0.05 and P < 0.001, respectively). The resection rate was not associated with PFS.CONCLUSIONS: EEA is a less invasive surgical approach for SBCs. The development of surgical instruments and postoperative radiotherapy will further improve patients' outcomes.