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。

Resection of giant clival chordomas via the extended subfrontal exdural approach(13 cases report)

Objective To evaluate the effects of surgical treatment of giant clival chordoma. Methods 13 giant clival chordomas were resected via the extended subfrontal exdural approach. The discussion was focused on the operative techniques, surgical results, causes of partial removal and treatment for residual tumor. Results In this group total tumor removal was achieved in 3 cases, subtotal in 7 and partial in 3, with no surgical death and severe complication. Follow up data up to 7 years in 12 cases were available, which showed no recurrence in 3 cases with total tumor removal, stable condition in 3 cases and death in 2 cases. 4 cases were re operated via different approach because of the tumor recurrence outside the midline region. Conclusions The follow up showed good results in patients with giant clival chordoma resected via the extended subfrontal exdural approach. The combined approach was recommended for the lesions outside the midline region.