神经内镜经双鼻孔入路在颅底外科中的应用

目的回顾性分析神经内镜经双鼻孔入路在颅底外科手术中的应用。方法收集70例颅底疾病患者神经内镜经双鼻孔入路行颅底手术治疗的临床资料。其中垂体腺瘤40例,鞍结节脑膜瘤11例,嗅沟脑膜瘤、脊索瘤、脑脊液鼻漏修补及视神经管减压各3例,颅咽管瘤、齿状突畸形各2例,眶内海绵状血管瘤、表皮样囊肿及鼻咽癌各1例。术后观察患者临床疗效。结果手术切除肿瘤62例,完全切除54例(87.1%),次全切除8例(12.9%);其中3例脑脊液鼻漏修补完全治愈,3例视神经管减压后视力好转,2例齿状突切除术后神经症状明显改善。结论神经内镜经双鼻孔入路能充分暴露鞍区等颅底结构,有效避免因空间狭窄所引起的操作不便,值得临床推广应用。

Application of bilateral endonasal neuroendoscopic approach to skull base surgery

Objective To analyze the application of bilateral endonasal neuroendoscopic approach to skull base surgery. Methods Clinical data of 70 patients undergoing skull base surgery via bilateral endonasal neuroendoscopic approach was analyzed retrospectively. The clinical superiorities mad application of this approach was summarized. This approach was adopted in the surgical treatment for pituitary adenoma （ n = 40 ） , suprasellar meningioma （ n= 11 ） , meningioma of olfactory sulcus （ n = 3 ） , notochordoma （ n = 3 ） , cerebrospinal rhinorrhea （ n = 3 ） , traumatic ophthalmic neuropathy （ n = 3 ） , Rathke＇ s tumor （ n = 2 ） , malformations of odontoid process （ n = 2 ） , intraorbital cavernous hemangioma （ n = 1 ） , epidermoid cyst （ n = 1 ） and nasopharyngeal carcinoma （ n = 1 ）. Results Of all the 70 cases, tumors of various kinds were confirmed in 62 cases with total removal in 54 （ 87. 1% ） and subtotal removal in 8 （12.9%）. Cerebrospinal fluid rhinorrhea were completely cured in all the 3 cases. The visual ability got improved after decompression of optic canal in 3 cases. The neurological symptoms were relieved significantly in the 2 patients by odontoidectomy. Conclusions Bilateral endonasal neuroendoscopic approach can fully expose skull base structures, effectively overcome the inconveniences induced by limited operation space. Through careful evaluation, proper strategy and suitable surgical approach, the highlights of therapeutic efficacy in skull base surgery can be shown.