颅底脊索瘤外科手术治疗探讨  

Investigation on the surgical treatment of skull base chordoma

作　　者：康暐 赵贤军[1] 段磊[1] 李强[1] 杨鹏宇[1] 潘亚文[1] KANG Wei;ZHAO Xian-jun;DUAN Lei;LI Qiang;YANG Peng-yu;PAN Ya-wen(Department of Neurosurgery,the Second Hospital of Lanzhou University,Insitute of Neurology,Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院神经外科兰州大学神经病学研究所

出　　处：《中国耳鼻咽喉颅底外科杂志》2019年第3期241-245,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：甘肃省自然科学基金(17JR5RA252)

摘　　要：目的探讨颅底脊索瘤的临床特点,诊断和手术治疗方法.方法回顾性分析54例接受手术治疗的颅底脊索瘤患者临床资料并介绍典型病例.结果 54例颅底脊索瘤患者头痛、视力受损症状最为常见,肿瘤全切19例(35.2%),次全切28例(51.8%),大部分切除7例(13.0%).41例患者术后临床症状有不同程度的缓解,35例肿瘤未达到全切者术后均行辅助放射治疗.随访3个月至4年,复发14例,脑脊液漏8例,颅内血肿6例,其中11例患者行二次手术.结论颅底脊索瘤手术治疗为主要方法,根据肿瘤的部位、特点及病变侵犯程度,辅助神经导航及神经电生理监测技术,选择不同手术入路,必要时联合入路,可提高肿瘤全切率,术后辅助放射治疗可延缓肿瘤复发.Objective To investigate the clinical characteristics, diagnosis and treatment of skull base chordoma. Methods Clinical data of 54 patients with skull base chordoma treated by surgery were analyzed retrospectively with presentation of typical cases. Results The most common symptoms of the 54 patients were headache and visual impairment. Total tumor resection was achieved in 19 cases (35. 2%), subtotal resection in 28 (51.2%) and most part resection in 7 (13. 0%). Clinical symptoms were relieved postoperatively in 41 patients, and postoperative radiotherapy was conducted in 35 patients without total tumor resection. Follow-up of 3 months to 4 years showed recurrence in 14 cases, 8 cases of cerebrospinal fluid leakage, 6 cases of intracranial hematoma and reoperation was performed in 11. Conclusions Surgical removal is the foremost treatment method for skull base chordoma. According to the location and characteristics as well as the degree of invasion of the tumor, the neuronavigation and neurophysiological monitoring techniques can be used to select proper surgical approach. The combined approach can raise the total resection rate if necessary. Postoperative adjuvant radiotherapy may postpone tumor recurrence.

关 键 词：脊索瘤 颅底肿瘤 手术治疗 

分 类 号：R739.41[医药卫生—肿瘤]