神经内镜扩大经鼻入路在颅咽管瘤手术的应用  

Application of neuroendoscopy in extended transnasal approach for craniopharyngiomas surgery

作　　者：蔡梅钦[1] 罗伦[1] 何海勇[1] 郑文汉 张保豫[1] 李文胜[1] 郭英[1] Cai Meiqin;Luo Lun;He Haiyong;Zheng Wenhan;Zhang Baoyu;Li Wensheng;Guo Ying(Department of Neurosurgery,the Third Affiliated Hospital,SUN Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院神经外科,广州510630

出　　处：《中国临床解剖学杂志》2021年第4期469-472,共4页Chinese Journal of Clinical Anatomy

摘　　要：目的探讨神经内镜扩大经鼻入路手术切除颅咽管瘤的疗效和安全性。方法回顾性分析2015年6月至2019年12月本院16例神经内镜扩大经鼻入路手术切除颅咽管瘤患者的临床资料。结果手术视野好,均在直视下显露及切除肿瘤。肿瘤全切除87.5%(14例),次全切除12.5%(2例)。12例术前视力损伤患者中,术后视力好转83.3%(10例)、无变化16.7%(2例)。术后出现新垂体功能低下56.3%(9例)、新尿崩37.5%(6例)。并发嗅觉减退25%(4例),脑脊液漏(12.5%)及肥胖(12.5%)各2例,颅内感染(6.3%)、脑积水(6.3%)及记忆力下降(6.3%)各1例。随诊2~59个月,无肿瘤复发。结论神经内镜扩大经鼻入路手术切除颅咽管瘤具有手术视野好,肿瘤全切除率、视力好转率高的优点;脑脊液漏及嗅觉下降的发生率较高,术中应重视颅底重建及对鼻腔黏膜的保护。Objective To evaluate the efficacy and safety of neuroendoscopic extended transnasal approach for selected craniopharyngiomas.Methods The clinical data of 16 patients underwent neuroendoscopic extended transnasal resection of craniopharyngiomas from June 2015 to December 2019 were analyzed retrospectively.Results All the tumors were removed under direct visualization.Gross-total resection was performed in 14 patients(accounting for 87.5%)and subtotal-resection in 2 patients(accounting for 12.5%).Among the 12 patients with preoperative visual impairment,the postoperative visual acuity improved in 10 patients(accounting for 83.3%)and remained unchanged in 2 patients(accounting for 16.7%).Postoperative hypopituitarism occurred in 9 cases(accounting for 56.3%),diabetes insipidus occurred in 6 cases(accounting for 37.5%).There were 4 cases(accounting for 25%)of hyposmia,2 cases of CSF leakage(accounting for 12.5%)and 2 cases of obesity(accounting for 12.5%),and 1 case of meningitis(accounting for 6.3%),1 case of hydrocephalus(accounting for 6.3%)and 1 case of memory deterioration(accounting for 6.3%)occurred postoperatively.There were tumor no recurrence after 2-59 months follow-up.Conclusions The surgical resection of craniopharyngiomas by extended neuroendoscopic transnasal approach has the advantages of excellent direct visualization of the tumors,high total resection rate and high visual improvement.CSF leakage and hyposmia were the major disadvantages of this approach,so the reconstruction of skull base and the protection of nasal mucosa should be paid more attention during the surgery.

关 键 词：神经内镜 扩大经鼻入路 颅咽管瘤 

分 类 号：R739.41[医药卫生—肿瘤] R323.1[医药卫生—临床医学]