Surgical results of an endoscopic endonasal approach for clival chordomas
Surgical results of an endoscopic endonasal approach for clival chordomas
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DOI：
10.1007/s00701-012-1317-1
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发表时间：
2012-05-01
影响因子：
2.4
通讯作者：
Yoshida, Kazunari
中科院分区：
文献类型：
--
作者：
Saito, Katsuya;Toda, Masahiro;Yoshida, Kazunari
斜坡脊索瘤的手术入路仍有争议，尽管切除范围是影响长期生存率的最重要因素之一。最近，与耳鼻喉科医生合作的鼻内镜入路作为斜坡脊索瘤的手术入路引起了广泛关注。我们描述了内窥镜经鼻入路的经验并提供了文献回顾。2008年至2011年间，通过内窥镜经鼻入路对斜坡脊索瘤进行了6例手术。平均肿瘤直径为35 mm。肿瘤主要发生在斜坡的中上部。肿瘤侵犯海绵窦5例，硬膜内3例。4例采用双鼻孔入路，2例采用单鼻孔入路，3例全切除。对未完全切除病例的分析表明，肿瘤残留在硬膜下和硬膜下。海绵窦上的残留物从后床突到海绵窦后室。另一方面，在垂体上部后面的硬膜下观察到残留物。在所有病例中，使用带血管的鼻中隔皮瓣术后均无脑脊液（CSF）漏。与其他方法相比，内窥镜下鼻内经肝叶入路可进行适当程度的切除，并发症发生率可接受。在我们的病例中，肿瘤全切除的完成与肿瘤与周围结构的关系有关，如垂体和颅内颈动脉（ICA）的海绵窦部分。
The surgical approaches for clival chordomas remain controversial, although the extent of resection is one of the most important factors for long survival rates. Recently an endoscopic endonasal approach in good collaboration with otolaryngologists has attracted major attention as a surgical approach for clival chordomas. We describe our experience with the endoscopic endonasal approach and provide a review of the literature.Between 2008 and 2011, six operations were performed via the endoscopic endonasal approach for clivus chordomas. The mean tumor size was 35 mm in diameter. The tumor location was mainly from the upper to middle clivus. The tumor extended into the cavernous sinus in five cases and intradurally in three cases. A binostril approach was performed in four cases, while a one nostril approach was performed in two cases.Gross total removal was achieved in three cases. The analysis of cases with incomplete resection suggested that residual tumors were observed epidurally and subdurally. The residual on the epidura was observed from the posterior clinoid to the posterior compartment of the cavernous sinus. On the other hand, the residual on the subdural was observed behind the upper part of the pituitary gland. There was no postoperative cerebrospinal fluid (CSF) leakage using vascularized nasoseptal flaps in any of the cases.The endoscopic endonasal transclival approach allows an appropriate extent of resection with acceptable complication rates in comparison with other approaches. In our series, the accomplishment of gross total removal was associated with the relationship between the tumors and surrounding structures, such as the pituitary gland and the cavernous portion of the intracranial carotid artery (ICA).