鼻内镜下颅底占位性病变的微创手术

目的探讨经鼻内镜在颅底占位性病变手术中的应用。方法回顾性分析2000年6月至2006年9月42例颅底占位性病变患者的临床资料。其中前、中颅底恶性肿瘤13例，脊索瘤8例，侵袭性垂体瘤向蝶窦、蝶鞍颅底破坏者5例，蝶骨骨纤维异样增殖症4例，翼腭窝、颞下窝神经纤维瘤3例，纤维血管瘤3例，前、中颅底骨化纤维瘤3例，其他病变3例。结果42例患者中，肿瘤完全切除36例，病变次全切除6例，2例因出血过多分两次完成手术，其余病变均1次完全切除。术后1例患者右眼失明，1例患者出现脑脊液耳漏，保守治疗1周后痊愈。42例均进行随访，随访6—81个月，其中5例失访，8例复发，6例死亡，其余患者未见复发。结论内镜下颅底占位性病变外科手术治疗安全、有效、微创，但需根据一定的技术、设备条件，严格掌握手术适应证。

Endoscopic surgery in occupation lesions of the skull base

OBJECTIVE: To explore the application of endoscopic endonasal approach in surgery for occupation lesions of the skull base. METHODS: Forty-two cases of skull base lesions treated by endoscopic endonasal surgery were analyzed retrospectively. There were 13 malignant tumors in anterior or middle cranial fossa, 8 chordoma, 5 invasive pituitary adenoma, 4 fibrous dysplsia of the sphenoid bone, 3 neurofibroma, 3 fibroangioma, 3 ossifying fibroma and 3 other lesions. RESULTS: Lesions were removed completely in 36 patients, 2 of them were performed in two stages because of sever bleeding, and subtotally in 6 patients. The complications included 1 acroisa of right eye and 1 cerebrospinal fluid otorrhea. Follow-up ranged 6 to 81 months after the surgery. Five patents were lost of follow-up. Eight patients recurred and 6 patients died. CONCLUSIONS: The endoscopic transnasal surgery is a safe, effective and minimally invasive approach to resect skull base lesions in condition of indications, surgeon's experience and the facilities.