A panoramic view of the skull base: systematic review of open and endoscopic endonasal approaches to four tumors.
A panoramic view of the skull base: systematic review of open and endoscopic endonasal approaches to four tumors.
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DOI：
10.1007/s11102-013-0508-y
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发表时间：
2014-08
期刊：
影响因子：
3.8
通讯作者：
Placantonakis, Dimitris G.
中科院分区：
文献类型：
--
作者：
Graffeo, Christopher S.;Dietrich, August R.;Grobelny, Bartosz;Zhang, Meng;Goldberg, Judith D.;Golfinos, John G.;Lebowitz, Richard;Kleinberg, David;Placantonakis, Dimitris G.
关键词：
鼻内镜手术已被确定为垂体瘤最安全的方法，但它在其他常见的颅底病变的作用尚未确定。为了回答这个问题，我们对四种主要颅底肿瘤的开放和内窥镜经鼻入路进行了系统回顾：嗅沟脑膜瘤（OGM），鞍结节脑膜瘤（TSM），颅咽管瘤（CRA）和斜坡脊索瘤（CHO）。对来自162项研究（包含5，701例患者）的数据进行了合并，并比较了围手术期死亡率、大体全切除（GTR）、脑脊液（CSF）漏、神经系统发病率、术后视功能、术后嗅觉丧失、术后尿崩症（DI）和术后肥胖/暴食症的差异。使用相对研究规模计算每个结局的加权平均率。我们的研究结果表明，开放手术和内镜手术治疗所有类型肿瘤的GTR率和围手术期死亡率相似。内镜手术后脑脊液漏增加。对于TSM、CRA和CHO，内镜手术后视觉功能症状更有可能改善。CRA开放性切除术后DI和肥胖/食欲亢进显著增加。OGM、TSM和CHO的内镜检查每1,000患者年随访复发率较高。开放手术和内窥镜手术的趋势表明，随着时间的推移，所有结局均略有改善。我们的观察结果表明，鼻内镜是一种安全的替代开颅手术，并可能是首选某些肿瘤类型。然而，内窥镜手术与更高的CSF泄漏率相关，并且可能增加复发率。需要长期随访的前瞻性研究来验证这些初步观察结果。
Endoscopic endonasal surgery has been established as the safest approach to pituitary tumors, yet its role in other common skull base lesions has not been established. To answer this question, we carried out a systematic review of reported series of open and endoscopic endonasal approaches to four major skull base tumors: olfactory groove meningiomas (OGM), tuberculum sellae meningiomas (TSM), craniopharyngiomas (CRA), and clival chordomas (CHO). Data from 162 studies containing 5,701 patients were combined and compared for differences in perioperative mortality, gross total resection (GTR), cerebrospinal fluid (CSF) leak, neurological morbidity, post-operative visual function, post-operative anosmia, post-operative diabetes insipidus (DI), and post-operative obesity/hyperphagia. Weighted average rates for each outcome were calculated using relative study size. Our findings indicate similar rates of GTR and perioperative mortality between open and endoscopic approaches for all tumor types. CSF leak was increased after endoscopic surgery. Visual function symptoms were more likely to improve after endoscopic surgery for TSM, CRA, and CHO. Post-operative DI and obesity/hyperphagia were significantly increased after open resection in CRA. Recurrence rates per 1,000 patient-years of follow-up were higher in endoscopy for OGM, TSM, and CHO. Trends for open and endoscopic surgery suggested modest improvement in all outcomes over time. Our observations suggest that endonasal endoscopy is a safe alternative to craniotomy and may be preferred for certain tumor types. However, endoscopic surgery is associated with higher rates of CSF leak, and possibly increased recurrence rates. Prospective study with long-term follow-up is required to verify these preliminary observations.
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