侵袭颅内嗅神经母细胞瘤

目的 探讨侵袭颅内嗅神经母细胞瘤临床特点及治疗方法。方法 对我院神经外科从2001年7月．2005年8月收治的5例侵袭颅内嗅神经母细胞瘤病人的临床表现、影像学特点、病理学特点，手术治疗进行分析，1例行内镜下经鼻活检，4例手术治疗，分别选择经额入路和经额扩展入路，应用不同方法进行颅底重建。全部病人术后行放疗，1例辅助化疗。术后6-45个月进行随访。结果 4例侵袭颅内肿瘤全部切除，术后鼻塞全部改善，3例术前视力下降者术后视力均有一定程度的改善，术后均未发生脑脊液漏，2例术后出现腰骶段椎管内转移，分别为术后6-8个月。其中1例手术，死亡1例。结论 侵袭颅内的嗅神经母细胞瘤治疗仍然需要多手段进行干预，对侵袭到颅内肿瘤要争取全切除，术后应辅以放疗。     

内镜经鼻颅内外联合入路切除前中颅底沟通瘤

目的 探讨内镜绛鼻颅内外联合入路切除前中颅底沟通瘤的手术方法.方法 对13例患者在扩大经额下入路显微切除肿瘤颅腔内部分的基础上,采用经鼻内镜下切除肿瘤颅外部分并重建颅底缺损.结果 手术全切除11例,次全切除2例,无手术死亡和新神经功能废损、脑脊液漏、脑膜腩膨出及颅内感染等并发症发生.术后病理爪神经鞘瘤4例,鼻咽纤维血管瘤3例,脑膜瘤2例,垂体瘤、内翻性乳头状瘤、鳞状细胞痛和嗅神经母细胞瘤符1例.结论 采用内镜经鼻颅内外联合入路切除前中颅底沟通瘤创伤小且深部视野良好,能安全且完全切除良性肿瘤.     

显微镜开颅联合内镜经鼻入路手术切除颅内侵袭性嗅神经母细胞瘤疗效分析

目的 总结颅内侵袭性嗅神经母细胞瘤的临床特点、手术策略和治疗效果.方法 纳入2005年1月至2020年12月在首都医科大学附属北京同仁医院诊断与治疗的24例颅内侵袭性嗅神经母细胞瘤患者,均行双侧扩大经基底入路联合内镜经鼻入路手术+颅底重建术.结果 24例患者肿瘤全切除22例(91.67％)、近全切除2例(8.33％),...     

9例嗅神经母细胞瘤治疗临床分析

目的探讨嗅神经母细胞瘤手术治疗的疗效及放射治疗的意义。方法回顾性分析2001-01—2013-12 9例嗅神经母细胞瘤经手术治疗患者的临床资料,根据Kadish分期,A期1例,B期7例,C期1例,全部患者随访12~84个月。结果经鼻内窥镜进路手术切除A期、B期5例,鼻侧切开进路手术切除B期3例,鼻侧切开加经颅进路手术切除C期1例,术后1例未作放疗,5个月后复发,8例术后加放疗肿瘤无复发。结论对于嗅神经母细胞瘤A期和B期的患者,经鼻内窥镜手术进路和鼻侧切开手术进路的治疗效果相当,鼻内窥镜手术具有术中视野清晰、局部组织损伤轻微、术后手术创面恢复较快等优势,是治疗鼻腔鼻窦嗅神经母细胞瘤的最有效手术方法,术后配合放疗,疗效更显著。     

扩大额下硬脑膜外入路切除颅底肿瘤

报告 Derome 一种改良的新的手术入路。由双侧游离额骨瓣与眶嵴和部分眶板一起形成,减少额叶牵拉,适用前、中和后颅底中线病变的手术。此入路手术16例,肿瘤全切除8例,次全和大部切除各4例,无手术死亡。15例随访0.5～9年,平均2.5年,10例无肿瘤复发、已复工,4例生活自理,1例嗅神经母细胞瘤术后3年死于肿瘤复发。     

神经内镜下经鼻蝶窦入路鞍区肿瘤的手术治疗

目的报道神经内镜下经鼻蝶窦入路切除59例鞍区肿瘤的方法和效果,探讨其优缺点和手术适应证。方法全部病人采用神经内镜下经鼻内-蝶窦标准入路和改良入路切除肿瘤。其中常规的神经内镜下经单侧鼻内-蝶窦入路36例,简化的神经内镜下经蝶窦入路16例,扩大的神经内镜下经蝶窦入路7例。4例手术中利用了神经导航技术。结果全切除肿瘤42例,次全切(>80%)7例,大部切除5例,引流3例,活检2例;本组病例术后1例死亡,7例有一过性脑脊液鼻漏;19例术后出现一过性多尿,术后3d-1周恢复正常,5例术后出现较长时间的多尿,4例经治疗术后3-6个月恢复正常,1例目前维持用药。随访3个月-3.5年,视力不同程度改善20例,异常增高的激素水平降至正常22例;4例手术后再接受了伽玛刀治疗,21例手术后3个月行普通放疗,1例垂体瘤1年后复发,再次接受导航辅助下内镜手术。结论神经内镜下经鼻蝶窦入路(包括标准入路和改良入路)适用于大多数鞍区肿瘤的切除,如垂体腺瘤、颅咽管瘤、鞍结节脑膜瘤等,可以获得满意的手术效果。     

Kadish C期嗅神经母细胞瘤的综合治疗

目的 探讨Kadish C期嗅神经母细胞瘤合理的治疗方法.方法 回顾性分析6例Kadish C期嗅神经母细胞瘤的临床资料.均采取以手术为主,结合放疗、化疗或同步放化疗等措施的综合治疗.其中3例为初治病例,3例为复发病例.6例术中送冰冻病理,切缘均阴性.结果 5例整块全切除的患者随访20个月以上,无复发;1例分块全切除的患者,术后11个月死于肿瘤复发.并发症包括3例气颅,2例精神症状,1例脑脊液鼻漏.结论 Kadish C期嗅神经母细胞瘤治疗宜选择以手术为主的多学科综合治疗.手术可采用经额下入路,无瘤原则和颅底重建非常重要.     

经颅入路联合神经内镜下经鼻蝶入路手术防治侧颅底脑膜瘤术后脑脊液漏

目的探讨经颅入路联合神经内镜下经鼻蝶入路手术防治侧颅底脑膜瘤术后脑脊液漏的效果。方法回顾性分析2016年1月至2020年8月经颅入路联合神经内镜下经鼻蝶入路手术治疗的20例侧颅底脑膜瘤的临床资料。结果 8例未延伸至海绵窦或眶上裂的肿瘤实现全切除;12例次全切除,为减少术后眼神经损伤的风险、有小块肿瘤残留在海绵窦或眶上裂。术后病理检查均为脑膜瘤(WHO分级Ⅰ级)。术后随访12～41个月,平均24.4个月,无脑脊液漏;13例肿瘤复发或进展,其中11例接受立体定向放疗,2例术后12、15个月再次手术。结论经颅入路联合神经内镜下经鼻蝶入路手术治疗侧颅底脑膜瘤,可有效预防术后脑脊液漏。当肿瘤切除导致经颅入路侧的带血管蒂皮瓣不可用、肿瘤延伸至副鼻窦时,建议优先考虑该种联合入路手术方式。     

鼻窦镜辅助下经单鼻孔入路垂体腺瘤显微手术切除

目的总结鼻窦镜辅助下经单鼻孔入路垂体瘤显微手术切除术的经验及初步体会.方法鼻窦镜辅助下,经单侧鼻腔,严格中线入路打开蝶窦前壁,暴露鞍底.然后在神经显微镜下行垂体瘤切除,最后鼻窦镜下鞍底重建.结果 21例患者中16例一次手术全切除,3例次全切除,1例巨大生长激素(growth hormone, GH)腺瘤大部分切除,后经改良翼点入路二次手术切除,1例巨大催乳素(prolactin, PRL)腺瘤分2次经蝶肿瘤切除,术后患者症状均改善.尿崩2例,分别于术后7 d、15 d停止;脑脊液漏1例,保守治疗2周治愈.结论耳鼻喉科医师解剖熟悉,鼻窦镜下显露鞍底准确充分,神经外科医师显微镜下可克服内镜单手操作的不便,二者结合有利于减少经单鼻孔入路垂体瘤切除的创伤,提高安全性,是一种有效的方法.     

手术切除从颅底侵犯海绵窦的肿瘤

目的探讨手术切除侵犯海绵窦的颅底肿瘤的指征及手术要点。方法自1998年11月至2002年5月，中日友好医院神经外科与中国医学科学院肿瘤医院头颈外科合作，连续切除侵犯海绵窦的颅底肿瘤32例，其中鼻咽纤维血管瘤7例，脊索瘤5例，鼻咽癌和鼻咽囊腺癌5例，副鼻窦癌5例，神经鞘瘤3例，嗅神经母细胞瘤1例，颞下翼腭窝低分化癌2例，颞下翼腭窝肉瘤3例，恶性纤维组织细胞瘤1例。23例曾经1次或多次手术切除后复发。对临床资料进行回顾性总结。结果根据肿瘤主体的部位分别选用经上颌骨入路、颞下耳前入路、或额眶入路。全部病例术中显露满意，肿瘤均得到肉眼切除，受累的颅神经一并切除，无手术死亡，术后无偏瘫等严重并发症。、术后辅以放射治疗。随访3—50个月，平均19个月，失访3例，4例术后3—6个月死亡，4例带瘤生仔，21例健在。结论由下向上侵犯海绵窦的颅底肿瘤可以手术切除，近期效果满意。对颅底正常和病理性解剖结构的熟练掌握以及多学科医生的密切协作是手术取得成功的关键。     

A case of olfactory neuroblastoma with intracranial extension and distant metastasis]

Olfactory neuroblastoma is a rare tumor originating in the upper nasal cavity. It rarely extends intracranially. We report a clinical case of olfactory neuroblastoma with intracranial extension and distant metastasis. A 35-year-old man complained of nasal stuffiness and bleeding, headache and vomiting. Neurological examination showed anosmia and papilledema. MRI showed a huge mass that occupied the right nasal and paranasal cavities, and extended into the right frontal base. The tumor was removed totally and was histologically diagnosed as olfactory neuroblastoma. About two months after surgery, however, MRI demonstrated a rapid recurrence of the tumor in the nasal and paranasal cavities and the frontal lobe. Metastatic lesions were also seen in the right cervical lymph nodes. Chemotherapy was administered using cisplatin and etoposide. The tumor in the frontal lobe shrunk markedly but the other lesion persisted. Whole brain irradiation and local irradiation of the cervical lymph nodes were performed. The tumors became smaller but did not disappear. MRI demonstrated spinal dissemination. Irradiation of the whole spinal cord was performed. The metastatic lesions disappeared. The patient was discharged without neurological deficits, but died of pneumonia 15 months after surgery. Olfactory neuroblastoma is a slow-growing tumor and is highly radiosensitive, but it rarely extends or develops multiple distant metastases and seldom shows a short survival time, as in our case. A review of the literature documented responses in patients treated with a cisplatin-based drug combination. We recommend systemic control using cisplatin-based chemotherapy in addition to irradiation to prevent local recurrence in cases of advanced or metastatic olfactory neuroblastoma.     

鞍结节脑膜瘤显微手术治疗体会

目的 探讨鞍结节脑膜瘤手术入路选择、手术技巧及临床效果.方法 回顾性分析2000年2月至2006年10月手术治疗的45例鞍结节脑膜瘤的临床资料,14例经单侧额下入路,15例经翼点入路,9例经眶额翼点入路,7例扩大经额入路.结果 肿瘤全切除42例,大部分切除3例;术后视力改善33例,无明显变化9例,3例恶化.结论 根据肿瘤大小、部位、生长方式及毗邻关系选择正确的手术入路并结合熟练的显微外科手术操作是全切除肿瘤及获得良好临床疗效的关键.

Abstract：

Objective To study the surgical approaches, operative techniques and curative effects of tuberculum sellae meningiomas. Method Retrospective analysis was made on 45 cases of tuberculum sellae meningiomas operated with a variety of surgical approaches. In 14 patients,the tumors were removed through unilateral subfrontal approach, 15 through pterional approach,9 through fronto - orbital craniotomy and 7 through extended frontal approach. Results Of the 45 cases, tumor was totally removed in 42 cases, subtotally removed in 3. Postoperatively, the eyesight was improved in 33 cases, unchanged in 9 cases, and worse in 3 cases. Conclusions The surgical approach for tuberculum sellae meningioma should be chosen according to the size, location, growth pattern and adjacent relation of tumor. The microsurgical skill is the key for total removal of tumor and good curative effect.     

改良翼点入路切除复杂型鞍区肿瘤27例临床分析

目的探讨改良翼点入路在切除各种不同复杂型鞍区肿瘤过程中的应用。方法对27例各种复杂型鞍区肿瘤病例经改良翼点入路手术切除术后进行回顾性分析。结果向鞍旁生长的鞍区肿瘤常选用经对侧翼点入路,向上斜坡生长的常选择经肿瘤侵犯生长对侧翼点入路。结论不同的改良翼点入路是切除向不同方向侵犯生长的复杂型鞍区肿瘤的重要方法。     

Olfactory groove meningiomas. Radical microsurgical treatment through the bifrontal approach

ObjectivesTo describe the microsurgical technique for the radical removal of olfactory groove meningiomas through the bifrontal approach. To review the diagnostic elements to be taken into account in the selection of the surgical approach to these tumours.Materials and methodsA microsurgical series of 35 olfactory groove meningiomas operated on through a bifrontal craniotomy is reviewed.ResultsThe mean tumoral volume was 85 cc (4.4 cm diameter). A relevant peritumoral brain edema was found in 65.7% of cases, hyperostosis in the implantation base in 80% and paranasal sinus invasion in 28.6%. A Sipmson grade 1 resection was achieved in every case. A patient died due to a postoperative pneumonia. Postoperative hospitalization time was between 3 and 20 days and at discharge all patients had a Glasgow Outcome Scale grade 4–5. The mean follow-up was 55.2 months. Two patients had postoperative transient rhinolicuorrhea and an additional patient developed hydrocephalus. An asymptomatic recurrence have been identified in a patient four years after surgery.ConclusionsIn our experience the bifrontal approach allowed the radical removal of huge olfactory groove meningiomas. The microdissection of the anterior cerebral artery A2 segments is possible thanks to the arachnoidal plane between vessels and tumor. Tumoral blood flow is secured by the early approaching of the base of the tumor and preoperative embolization is not necessary. Bifrontal approach allows an aggressive treatment of the hyperostosis, bone infiltration and paranasal sinus invasion. Anterior fossa reconstruction is done using a vascularized periosteal flap.     

微血管多普勒监测下显微手术治疗基底动脉顶端动脉瘤（附10例报告）

目的总结基底动脉顶端动脉瘤的临床特征、手术入路和治疗效果。方法2007年1月至2011年12月在微血管多普勒监测下手术治疗基底动脉顶端动脉瘤10例,其中7例采取翼点入路和3例采取扩大翼点入路手术夹闭。结果10例患者共夹闭13个动脉瘤,切除2个动静脉畸形。9例恢复良好,1例术后1周自动出院后死亡。1例轻偏瘫患者于出院后4周恢复,2例出现动眼神经麻痹的患者均于出院后3个月内恢复。9例随访10个月-5年,均未见动脉瘤复发。结论显微手术是治疗基底动脉顶端动脉瘤重要手段。翼点入路和扩大翼点入路可以有效暴露动脉瘤。微血管多普勒在基底动脉顶端动脉瘤夹闭术中是一种直接、有效和便捷的监测方法。     

Olfactory groove meningiomas.

Meningiomas originating from the olfactory groove account for approximately 10% of all intracranial meningiomas. They represent only 2% of all intracranial tumors. We present the diagnostic, clinical and pathological features of olfactory groove meningiomas and describe our surgical results and complications in a series of 25 patients. In 19 patients, surgery was via a bifrontal approach, and in the remaining six a pterional approach was used.     

经额外侧入路显微外科手术治疗大型嗅沟脑膜瘤

目的探讨经额外侧入路切除大型嗅沟脑膜瘤的手术方法及治疗效果。方法回顾性分析我院神经外科2013年3月至2014年4月利用显微外科手术切除的18例大型嗅沟脑膜瘤患者的临床资料。手术均采用额外侧入路。结果肿瘤全部切除(SimpsonⅠ、Ⅱ级)17例,次全切除(SimpsonⅢ级)1例,无手术死亡病例,术后随访疗效满意。结论经额外侧入路分块切除大型嗅沟脑膜瘤符合微侵袭手术理念,可以作为大型嗅沟脑膜瘤手术切除的一种选择术式。     

Venous saving in olfactory meningioma's surgery

Bifrontal craniotomy and interhemispherical approach, usually used to remove olfactory groove meningioma, does not allow a view of posterior pole, which is very important in the surgical management of this neoplasm, and, provides for an anatomical sacrifice of frontal bridging veins, not without complications as a result of venous infarction. From 1975 the pterional approach was performed on 20 patients with olfactory meningioma, with good results in 90% of cases. This approach presents several advantages over bifrontal craniotomy and, in order to minimise surgical damage, it avoids planned sacrifice of venous vessels.     

鞍结节脑膜瘤的显微手术治疗

目的 探讨鞍结节脑膜瘤的显微手术治疗方法及其效果。方法 回顾性分析2007年1月至2013年7月显微手术治疗的45例鞍结节脑膜瘤患者的临床治疗,采用单侧额下入路22例,纵裂入路5例,翼点或扩大翼点入路15例,翼点及额下联合入路3例。结果 肿瘤全切除程度:Simpson分级Ⅰ级23例,Ⅱ级14例,Ⅲ级5例,Ⅳ级3例;肿瘤全切除率达82.2%。术前合并不同程度视力障碍的37例患者中,术后视力较术前好转27例,无明显变化6例,恶化4例;视力改善率73.0%。结论 鞍结节脑膜瘤周围毗邻重要结构,显微手术是其的主要治疗方法;手术时应根据肿瘤大小、生长方式、视力受损程度及术者习惯等选择不同的入路;熟悉的显微解剖知识、娴熟的显微外科技巧是手术成功的关键。