经鼻蝶入路切除鞍区斜坡肿瘤

目的:探讨经鼻蝶入路切除鞍区斜坡肿瘤的优缺点。方法:经鼻蝶显微手术。结果:对118例鞍区斜坡肿瘤采用鼻蝶入路手术切除,效果满意,107例垂体腺瘤行全切或次全切除。3例囊性颅咽管瘤行永久性引流,6例脊索瘤行次全切除。结论:合理应用本手术入路,对某些颅底肿瘤的切除是一有效的途径。     

扩大额下硬膜外入路切除巨型斜坡脊索瘤(附13例报告)

目的　探讨巨型斜坡中线区脊索瘤的手术治疗方法。方法　采用经扩大额下硬膜外入路切除 13例巨型斜坡脊索瘤 (直径大于 4cm)。介绍入路方法、肿瘤切除程度和疗效随访 ,探讨肿瘤残留的原因和处理 ,并与其它入路比较适用范围。结果　本组巨型斜坡脊索瘤全切除 3例 ,次全或大部切除 7例 ,部分切除 3例 ,无手术死亡 ,无严重并发症。随访2～ 7年 ,3例肿瘤全切除者未见复发 ,其余 10例中 2例死亡 ,1例失访 ,3例病情稳定 ,另 4例因斜坡中线区以外肿瘤复发经其它入路再次手术 ,生存至今。结论　采用扩大额下硬膜外入路 ,切除主要沿颅底中线方向生长的巨型斜坡脊索瘤 ,疗效满意。对偏离中线方向生长的较大肿瘤 ,须采用联合入路手术。     

斜坡脊索瘤的手术治疗

目的总结30例斜坡脊索瘤的手术治疗方法和疗效。方法;经多种人路手术切除肿瘤。结果本组斜坡脊索瘤全切除6例,次全或大部切除18例,部分切除6例。随访20例,时间平均4．5年。11例患者病情好转或稳定,6例肿瘤复发再次手术后好转,3例死亡。结论根据斜坡脊索瘤的侵及范围、大小,选择合适的手术人路;全切除肿瘤是治疗的最有效方法,对于不全叨除者加用放疗可延缓肿瘤生长。     

扩大经蝶入路手术治疗蝶斜区脊索瘤

目的 探讨采用扩大经蝶入路手术切除蝶斜脊索瘤的方法.方法 12例患者采用标准经鼻中隔蝶窦入路,先行切除经蝶入路视野内的肿瘤,然后调整Hardy扩张器方向指向斜坡方向,进行手术入路的扩大.根据术前影像学资料、术中"C"型臂监测、神经导航、神经内镜以及术者的经验决定斜坡骨质磨除或咬除的范围,直至显露正常骨质和硬脑膜,显微镜下切除肿瘤.结果 全切8例(67%),次全切3例(25%),部分切除1例(8%).结论 采用扩大经蝶入路手术治疗蝶斜区脊索瘤,显露满意、全切率高,无明显手术并发症.而神经导航、神经内镜的应用,使得该入路更为安全有效.     

颅底脊索瘤的内镜经鼻手术治疗分型及入路

目的 探讨一种适合内镜经鼻手术治疗需要的颅底脊索瘤临床分型及入路选择方法.方法 回顾性分析2007年8月至2012年8月于我院使用内镜经鼻手术治疗的133例颅底脊索瘤病例资料.依据内镜经鼻手术斜坡解剖区域分类方法对脊索瘤进行临床分型.其中,主体位于颅底中线区域116例:(1)主体位于前颅底6例;(2)主体位于上斜坡7例;(3)主体位于上中斜坡42例;(4)主体位于中下斜坡8例;(5)主体位于下斜坡21例;(6)主体位于全斜坡32例.主体位于中线及中线旁区域(广泛型)17例.全部病人均行内镜经鼻手术切除.中线区域型共使用4种内镜经鼻手术入路:内镜经鼻-前颅底入路、内镜经鼻-上斜坡入路、内镜经鼻-中斜坡入路、内镜经鼻-下斜坡入路.广泛型使用内镜经鼻手术入路结合其他开颅手术入路进行肿瘤切除.结果 病变全切为26例(20％),次全切62例(47％),大部切除38例(29％),部分切除7例(5％).结论 制定适合内镜经鼻手术的斜坡解剖区域划分,并以此为基础对颅底脊索瘤进行临床分型,可以更好地指导内镜经鼻切除颅底脊索瘤的手术入路选择.     

颅底与颈椎脊索瘤13例临床分析

目的 探讨颅底及颈椎脊索瘤手术治疗方法及疗效。方法 回顾性分析2009年3月至2013年10月收治的13例颅底及颈椎脊索瘤患者临床资料。根据肿瘤生长部位及特点,包括原发及复发病例,颅底脊索瘤分别采用经鼻蝶入路7次、经鼻蝶联合经口入路2次、翼点入路1次和乙状窦后入路2次;颈椎脊索瘤采用颈椎后路切除及内固定术4次。结果 13例病人术后随访2~60个月,平均随访21个月。首次手术后全切除7例（53.8%）,次全切除4例（30.8%）,部分切除2例（15.4%）。术后行放射治疗7例。术后复发4例,3例再次行手术治疗,1例行放射治疗。结论 依据肿瘤的生长部位和特点选择合适的手术入路是颅底和颈椎脊索瘤手术成功的关键,经鼻蝶入路鼻内镜辅助下手术为颅底脊索瘤提供了一种更加安全和有效的全切除肿瘤的方法,术后给予放射治疗可以延缓肿瘤的复发。     

经上颌骨翻转入路手术切除斜坡脊索瘤

目的探讨采用经上颌骨翻转入路手术切除Al-MeftyⅢ型斜坡脊索瘤的方法及临床意义。方法对8例Al-MeftyⅢ型斜坡脊索瘤病人采用经上颌骨翻转入路行手术切除。结果均达到显微镜下肿瘤全切除。术后随访2-50个月，平均27个月；1例发现有肿瘤复发，但生活质量良好，余病人无复发。手术并发症包括创腔感染1例，咽喉部肿胀致阻塞性通气困难1例，均治愈。结论经上颌骨翻转入路手术切除Al-MeftyⅢ型斜坡脊索瘤具有显露充分，肿瘤切除彻底，不损伤脑组织等优点。     

颅底脊索瘤的显微外科治疗

目的 探讨脊索瘤的诊断及综合治疗。方法 对105例颅底脊索瘤作回顾性分析研究。结果手术108例次，有3例病人复发后再次行手术治疗。肿瘤全切除14例次，近全切除65例次，全切和次全切除率为73．2％，大部及部分切除29例次。手术死亡2例。108例次手术中有34例次术后出现并发症。结论 采用显微外科治疗方法，选择适当的手术入路，是提高肿瘤切除率，降低术后并发症是治疗的关键所在。     

经鼻内镜斜坡脊索瘤和脊索肉瘤的外科治疗

目的探讨经鼻内镜外科技术在斜坡脊索瘤和脊索肉瘤治疗中的应用、方法2002年11月～2006年2月对7例脊索瘤和2例脊索肉瘤行经鼻内镜手术，其中3例是复发病例、所有病例均有头痛，复视4例．视力障碍或失明3例，鼻塞、嗅觉减退或失嗅4例，面部麻木1例。肿瘤同时侵犯海绵窦和颈内动脉4例。岩尖区5例．寰枢椎2例．随访时间3～39个月。结果6例脊索瘤和1例脊索肉瘤术中内镜下及术后影像学证实完全切除，1例脊索瘤和1例脊索肉瘤次全切除．1例术后出现蛛网膜下腔出血。至随访期结束．7例病人无复发。1例带瘤生存。1例行脊索瘤次全切除的病人5个月后复发。结论经鼻内镜治疗斜坡脊索瘤和脊索肉瘤可以更好地辨认深部结构．视觉效果好，可以大范围切除病变。同时，可以简单迅速地到达斜坡区域。对斜坡脊索瘤和脊索肉瘤是一种较好的手术入路。     

内镜经鼻蝶手术治疗颅底脊索瘤

目的探讨内镜下经鼻蝶治疗颅底脊索瘤的技术、方法和手术指征。方法自2000年6月至2006年6月,应用神经内镜经鼻蝶入路手术治疗颅底脊索瘤30例。29例应用30°,70°硬性神经内镜,经鼻中隔和中鼻甲间入路,用高速磨钻磨除相应的骨性结构,显露肿瘤并分块切除。1例在显微外科下开颅切除颅内部分肿瘤,然后在神经内镜引导下,经鼻蝶切除斜坡、鞍区蝶筛窦、上颌窦、颞下窝的肿瘤。18例在术后6-12个月获得随访。结果肿瘤近全切除7例,次全切除16例,部分切除7例。24例术后获得一定程度上的临床症状和体征的改善,6例无变化。所有病人在术后7- 10d可恢复日常生活。1例在出院后20d因脑脊液漏再次入院做修补手术。随访的18例中,有4例在术后10-18个月复发,这4例均为广泛性生长的病例。结论内镜经鼻蝶手术治疗颅底脊索瘤有明显的优势。其操作简便安全;术中视野清楚,有利于显露;术后严重并发症少,病人恢复快,住院时间短。     

经蝶入路颅底脊索瘤的显微手术治疗(附15例分析)

目的总结经蝶入路治疗颅底脊索瘤的手术经验。方法回顾性分析15例颅底脊索瘤病人的病例资料。肿瘤位于鞍区和中上斜坡13例,其中累及鞍内、鞍旁、蝶窦3例;呈侵袭性生长,累及中上斜坡和多组鼻窦2例。均采用经蝶窦入路手术。结果肿瘤全切除4例,次全切除8例,部分切除3例。术后临床症状得到不同程度改善11例,无明显缓解4例;无术后脑脊液漏、颅内感染等手术并发症发生,无死亡病例。部分切除病例中,术后12个月复发2例,术后2年复发伴远隔部位转移1例。结论对于局限于鞍区或中上斜坡及向鼻旁窦方向侵袭生长的颅底脊索瘤,经蝶窦入路可以很好地显露病变。该入路切除病变操作安全、省时,术后并发症少,病人恢复良好。     

Bone invasiveness is associated with prognosis in clivus chordomas

Clivus chordomas present a great challenge for neurosurgeons, and the prognosis is poor. To investigate bone invasiveness characteristics in regard to the prognosis of clivus chordomas, a retrospective study of 19 patients with primary clivus chordoma was performed. Clinical data, MRI, CT scans and follow-up data were examined, and the bone invasiveness of the chordoma was classified into two growth patterns (endophytic and exophytic) which were analyzed with regard to prognosis. The overall survival rate was 78.9% with radical surgery and adjuvant radiation, with a mean follow-up of 44.5 months. There were 12 patients in the endophytic group and seven in the exophytic group, and the exophytic group exhibited a higher recurrence rate than the endophytic group (p = 0.006). Chordomas with an exophytic growth pattern were more likely to recur than those with an endophytic growth pattern, and the surgical approach can be tailored according to each growth pattern.     

Ectopic pituitary adenoma of the clivus presenting with apoplexy: case report and review of the literature

Ectopic pituitary adenomas usually occur within sphenoid sinus or nasopharynx, and seldom within the clivus. There is only a single reported example of ectopic adenoma with clinical apoplexy, albeit not from clivus. We report a 78-year-old male with known prostate carcinoma admitted with acute onset of blurred vision, suggestive of apoplexy. Work-up revealed unilateral cranial nerve VI palsy and neuroimaging showed a mass confined to the clivus; sellar region was normal. Preoperative considerations included chordoma, chondrosarcoma, or metastatic prostate carcinoma to bone. Resection was via endoscopic transsphenoidal approach to the clivus. An ectopic null cell pituitary adenoma with bland infarction was identified as the cause of the patient's clinical apoplexy. No antecedent precipitating factors for apoplexy were present; specifically the patient had not received leuprolide preoperatively, a known precipitant of pituitary apoplexy in prostate cancer patients who receive drug. We review the literature on ectopic clival pituitary adenomas, apoplexy in ectopic adenomas, and the link between apoplexy and leuprolide usage.     

Surgical approaches: postoperative care and complications “posterolateral–far lateral transcondylar approach to the ventral foramen magnum and upper cervical spinal canal”

Background  Lesions that affect the lower clivus, foramen magnum, the craniocervical junction, and the upper cervical spinal canal that are anterolateral and at times intradural require access ventral to the cerebellum and spinal cord. The posterolateral transcondylar approach provides such a route. In addition, posterior craniocervical stabilization can be accomplished at the same time. The author has reviewed the technique as well as the surgical results here. Materials and methods  The posterolateral transcondylar approach to the craniocervical junction was utilized in children with schwannoma, meningioma, and chordoma affecting the cervicomedullary junction. Other entities such as neurenteric cysts and hemangioblastoma were also seen. Extradural tumors such as aneurysmal bone cysts of the atlas and the axis vertebrae as well as proatlas segmentation abnormalities and bone tumors were seen. The stability of the craniocervical junction was assessed preoperatively so that a fusion procedure could be accomplished at the same operative setting, if necessary. Preoperative evaluation of the lower cranial nerves was vital. The surgical procedure was accomplished in the prone position. The occipital bone removal was carried out up to the sigmoid sinus and toward the jugular bulb. Relocation of the vertebral artery was made at the atlas vertebra and thus provided posterolateral exposure into the posterior fossa and upper cervical spinal canal. Occipital condyle removal was limited to one-third of the medial occipital condyle. Results  Twenty-five children underwent a posterolateral transcondylar approach. New lower cranial nerve dysfunction occurred in two and only one required a tracheostomy. This was seen in a child with clivus chordoma. A complete removal was accomplished in meningioma and schwannoma as well as in neurenteric cyst and hemangioblastoma. Clivus chordomas required more than one surgical procedure. The tumors of the bone were all treated with simultaneous fusion. Conclusions  The posterolateral transcondylar route is a versatile avenue to approach a variety of lesions ventrolateral to the brain stem and upper cervical cord. Exposure is quite satisfactory with minimal or no retraction of important neurovascular structures in the region. Modifications of this theme can be applied as the lesions require.     

Endoscopic management of a lower clival chondroid chordoma: case report

We report herein a case of lower clival chondroid chordoma, focusing on the surgical procedure of endoscopic endonasal surgery. A 36-year-old woman presented with progressive headache, right shoulder pain, and right hypoglossal nerve palsy. Computed tomography (CT) and magnetic resonance (MR) imaging revealed an extradural tumor located in the lower clivus, including the anterior aspect of the foramen magnum, deeply compressing the medulla and upper cervical spinal cord. Endoscopic endonasal surgery was performed via two nostrils. Since the basiocciput was destroyed by the tumor, removal of the tumor allowed identification of the middle clivus superiorly, the anterior arch of the atlas inferiorly, and anteromedial parts of occipital condyles bilaterally without drilling the basiocciput. The tumor was removed except for laterally and inferiorly extended lesions. Pathological diagnosis was chondroid chordoma. Postoperative course was uneventful, and the patient was discharged without further neurological deterioration. Endonasal endoscopic surgery provided safe and reliable tumor resection for a lower clival lesion. We believe that this minimally invasive procedure should be considered as an alternative to traditional surgical treatment.     

经口-硬腭入路切除斜坡脊索瘤

作者采用经口腔入路,并切除硬腭,能很好地暴露斜坡上部至颅颈交界处,成功地切除1例儿童巨大斜坡脊索瘤。由于保留硬腭的粘骨膜和软腭,可以重建口腔顶部,术后病人的发音和吞咽功能不受影响。     

内镜经鼻颅底手术中骨性解剖标志的临床意义

目的探讨内镜经鼻颅底手术中骨性解剖标志的临床意义。方法测量100例干性颅底骨性标本的相关解剖数据;并分析2000年9月～2007年3月进行的172例内镜经鼻颅底手术录像,评价中鼻甲、筛窦、蝶窦腔内骨性隆起、蝶骨翼突等作为骨性解剖标志的临床意义。结果骨性解剖数据:两侧翼突内侧板、枕髁前缘和破裂孔间距分别为26.47mm、16.92mm和19.98mm;视神经管与破裂孔、卵圆孔和下颌关节窝内缘距离约26mm、30mm和44mm。在172例内镜经鼻颅底手术中,与手术入路相关的并发症包括颈内动脉损伤1例,视神经损伤1例,其他并发症包括脑脊液鼻漏14例,蛛网膜下腔出血1例,脑膜炎致死1例;中鼻甲、筛窦、蝶窦腔内骨性隆起及蝶骨翼突是内镜经鼻前颅底、鞍区、斜坡、海绵窦、颞下窝和翼腭窝手术中指导手术的重要解剖标志。结论颅底骨性解剖标志对于内镜经鼻颅底手术有指导作用,正确认识这些解剖标志有助于提高手术安全性。     

Dostęp skalisty przedni – analiza techniki operacyjnej na podstawie symulacji na zwłokach

The aim of the study was to present consecutive stages of the anterior petrosal approach (APA).Eight simulations of APA were performed on non-fixed human cadavers without any known pathologies of the head and neck. The consecutive stages of the procedure were documented with photographs and schemes.The starting point for APA is a temporal craniotomy and extradural exposition of the base of the middle cranial fossa. Mobilisation of the trigeminal nerve allows for removal of the apex of the petrous bone. Approach to the upper part of the clivus is achieved by elevation of the temporal lobe and section of the tentorium and superior petrosal sinus with surrounding dura.Anterior petrosal approach is a reproducible technique, which provides surgical penetration of the upper clivus and related regions. This approach is particularly useful in the treatment of tumors of the mentioned above anatomical areas.