内镜经鼻联合显微镜额眶颧颞入路处理颅内外沟通性肿瘤的临床分析

目的探讨内镜经鼻入路联合显微镜额眶颧颞入路在颅内外沟通性肿瘤手术中的应用。方法回顾分析2016年5月至2018年1月在天津市环湖医院采用内镜经鼻联合显微镜额眶颧颞入路进行手术治疗的7例颅内外沟通性肿瘤患者的临床资料。7例患者中男4例,女3例,年龄27~65岁,中位年龄48岁。7例患者中2例复发侵袭性垂体瘤,3例颅底脑膜瘤,1例斜坡软骨肉瘤,1例复发鼻咽癌。病变广泛累及鼻腔、鼻窦、双侧海绵窦、鞍区、鞍上、上斜坡、颞叶、翼腭窝、颞下窝以及颅内重要血管。7例患者均采用全身麻醉下内镜经鼻入路联合显微镜额眶颧颞入路肿瘤切除治疗,观察手术全切情况、术中术后并发症情况以及术后疗效。所有患者术后随访6~12个月,采用格拉斯哥预后分级(Glasgow outcome scale,GOS)评估患者预后。结果 7例患者中肿瘤全切5例,大部切除2例。术中未出现并发症。术后发生严重并发症2例:其中1例脑脊液鼻漏并颅内感染,经腰大池引流和鞘内注射药物治疗后治愈;1例动眼神经麻痹,随访期间内未恢复。术后其他并发症包括滑车神经功能障碍1例次,耳鸣1例次,面部麻木2例次,随访中部分神经功能恢复。术中术后无死亡病例。7例患者术后随访均无肿瘤复发,且7例患者GOS评分均达Ⅳ~Ⅴ级。结论内镜经鼻联合显微镜额眶颧颞入路处理复杂性颅内外沟通性肿瘤可一期切除肿瘤,手术并发症较少,具有较好的临床应用前景。

Analysis on endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach under the microscope for skull base tumor with intra and extra-cranial involvement

Objective To evaluate the application of combination use of endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically in skull base tumor with intra and extra-cranial involvement.Methods A total of 7 patients(4 males and 3 females,aging from 27 to 65 years old,with a medium age of 48)undergone complicated skull base surgeries via endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically from May 2016 to January 2018 were reviewed respectively.The patients included 2 cases of recurrent invasive pituitary adenoma,3 cases of basal skull meningiomas,1 case of clivus chondrosarcoma,and 1 case of recurrent nasopharyngeal carcinoma.The lesion extensively infiltrated nasal cavity,extending to the paranasal sinus,bilateral cavernous sinus,sellar region,suprasellar,superior clivus,temporal lobe,pterygopalatine fossa,infratemporal fossa and important intracranial vessels.All the 7 patients were treated under general anesthesia by endoscopic endonasal approach combined with frontotemporal orbitozygomatic approach under the microscope.Total excision rate,intraoperative and postoperative complications and postoperative curative effect were observed.All of them were followed up for 6 to 12 months.The Glasgow Outcome Scale(GOS)was used to evaluate the prognosis.Result Total tumor removal was performed in 5 cases,subtotal removel in 2 cases.There was no complication during the operation.Postoperative severe complications occurred in 2 cases,including 1 case of cerebrospinal fluid rhinorrhea and intracranial infection,which was cured by lumbar cistern drainage and intrathecal injection;1 case occurred oculomotor nerve paralysis,which recovered during follow-up.Postoperative complications occurred in 1 case of trochlear nerve dysfunction,2 cases of facial numbness,and 1 case of tinnitus.During follow-up,all patients recovered to varying degrees.There was no bleeding and death after the operation.No tumor recurred during the follow-up period.All patients were recovered well with GOS gradeⅣ-Ⅴ.Conclusions Endoscopic transnasal approach combined with microscopic frontotemporal orbitozygomatic approach can remove tumors in one stage,reduce surgical complications and improve surgical effect.It has good application prospects and is suitable for excising complex intracranial and extracranial communicating tumors of widely involving sellar,clivus and petrous apex area.