颅底肿瘤显微手术进展

颅底肿瘤显微手术治疗的目标是能够最大程度地保护神经功能，降低病残率，保持患者最佳的生活质量．并不是以单纯地追求肿瘤的全切除率为目的。在这一理念指导下，越来越多的微创技术逐渐应用于颅底肿瘤的治疗中，并在实践中不断改进、丰富与完善．不再盲目追求过多地切除颅底骨质。立体定向放射外科，神经内镜技术、神经导航技术的发展和完善，为颅底肿瘤的“微创”治疗提供了更多的选择和保证。神经影像学技术的发展，如功能磁共振、质子磁共振波谱等使得颅底肿瘤的术前、术后评估更加全面；体感诱发电位、脑干听觉诱发电位等电生理监测手段被广泛应用于颅底肿瘤的术中监测。经典的手术入路被越来越熟练地应用并进行了有效的扩展，例如经蝶手术已经能够切除90％以上的垂体腺瘤，而扩大经蝶亦能够处理斜坡、海绵窦及部分前颅底中线的肿瘤；复杂的手术入路逐渐被简化的手术入路所代替，如颞枕开颅经岩骨嵴入路及乙状窦后经内听道上嵴入路替代其它联合入路切除岩斜脑膜瘤。总之，治疗方案和手术入路的选择更趋向于个体化，如何最大限度地保护神经功能，改善手术后患者的生活质量，依然是颅底外科发展的主要方向。

Advances in Microsurgical Treatment of Skull Base Tumors

The goals of microsurgical treatment of skull base tumors are to minimize morbidity while preserving neurological function to the greatest extent possible and keeping the optimal quality of life, not to pursue the total resection simply. So more and more minimally-invasive techniques are applied to the treatment of skull base tumors and removing skull base bone excessively is not used regularly. The development of stereotactic radiosurgery, endoscopic neurosurgery and neuronavigation provides more choices for the treatment of skull base tumors. The advances of neuroimaging, for example, functional MRI and proton MR spectroscopy, make the pre- and postoperative evaluation more accurate. The electrophysiologic monitoring methods, such as SEP and BAEP, are applied to the intraoperative monitoring widely for the treatment of skull, base tumors. Classic neurosurgical approaches have been used more practised and some are extended effectively, for exampie, the extended transphenoidal approach can treat the tumors involving clivus, cavernous sinus and the mid- !.ine of anterior cranial fossa. CompLicated approaches have been replaced by the simplified graduaLLy. In a word, how to protect neurological function and better quality of life of postoperative patients to the greatest extent possible are still the main trend of skull base surgery.