三维神经内镜在经鼻颅底外科手术中的初步应用  

Preliminary application of three-dimensional neuroendoscopy in transnasal skull base surgery

作　　者：辛国 熊奕诚 谢申浩 罗海 肖利民[1] 洪涛[1] 唐斌[1] Xin Guo;Xiong Yicheng;Xie Shenhao;Luo Hai;Xiao Limin;Hong Tao;Tang Bin(Department of Neurosurgery,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院神经外科,南昌330006

出　　处：《中华神经外科杂志》2022年第2期123-127,共5页Chinese Journal of Neurosurgery

基　　金：江西省科技厅重点研发计划(20192BBG70026)。

摘　　要：目的初步探讨三维(简称3D)神经内镜在经鼻颅底外科手术中的应用效果。方法回顾性分析2021年2—5月南昌大学第一附属医院神经外科采用3D神经内镜行经鼻颅底手术的28例患者的临床资料。病变包括垂体腺瘤18例,其中非侵袭性垂体腺瘤11例,侵袭性垂体腺瘤7例;颅咽管瘤6例;鞍结节脑膜瘤2例;鞍上Rathke囊肿1例;脊索瘤1例。根据不同病变分别选择3D神经内镜经鞍底入路(12例)、经鼻蝶-鞍结节-蝶骨平台入路(8例)、经斜坡入路(2例)、经翼腭窝-海绵窦入路(6例)。术后行影像学随访了解肿瘤是否复发和颅底重建情况。结果28例患者中,肿瘤全切除26例,次全切除2例。术前视力下降20例,术后18例好转,2例加重;术前头痛8例,术后均予以缓解;术前闭经2例,术后月经均恢复正常;术前尿崩4例,术后均无明显缓解。术后新增尿崩3例,均为短暂性尿崩,经药物治疗后好转;新增外展神经麻痹1例。术后无脑脊液漏及颅内感染患者,无手术相关死亡病例。28例患者的随访时间为(4.7±1.1)个月(3~6个月),复查MRI未见肿瘤复发者,无迟发性脑脊液漏者。结论3D神经内镜应用于经鼻颅底外科手术中可立体显示组织结构及病变与重要神经血管之间的空间关系,从而减少损伤、提高肿瘤的切除率。Objective To preliminarily explore the effect of three-dimensional(3D)endoscopy in transnasal skull base surgery.Methods A retrospective analysis was conducted on the clinical data of 28 patients who underwent transnasal skull base surgery with 3D endoscopy in the Department of Neurosurgery,the First Affiliated Hospital of Nanchang University from February 2021 to May 2021.Those cases included 18 cases of pituitary adenomas(11 cases of non-invasive pituitary adenomas and 7 cases of invasive pituitary adenomas),6 cases of craniopharyngiomas,2 cases of tuberculum sellae meningiomas,1 case of suprasellar Rathke cyst and 1 case of chordoma.According to the specific lesion,different approaches were adopted and included transsellar approach(12 cases),transsellar tubercle sphenoid platform approach(8 cases),transclival approach(2 cases)and transpterygopalatine fossa cavernous sinus approach(6 cases).Follow-up imaging was performed to evaluate the extent of tumor resection and the reconstruction of the skull base.Results Among the 28 patients,complete resection was achieved in 26 and subtotal resection in 2.Visual acuity decreased in 20 cases before operation,18 cases improved after operation,and 2 cases got worse after operation.There were 8 cases reporting headache before operation and all were relieved after operation.There were 2 cases of amenorrhea before operation and their menstruation returned to normal after operation.There were 4 cases of diabetes insipidus before operation,none of which showed obvious relief after operation.There were 3 cases of newly-developed diabetes insipidus after operation,all of which were transient and improved after drug treatment.There was 1 case of newly-developed abducens nerve palsy.There were no patients with cerebrospinal fluid rhinorrhea or intracranial infection.There were no deaths related to surgery.The follow-up time of 28 patients was 4.7±1.1 months(3-6 months).Re-examination of MRI showed no tumor recurrence and no delayed cerebrospinal fluid leakage.Conclusions The 3D n

关 键 词：自然腔道内镜手术 成像 三维 颅底肿瘤 治疗结果 

分 类 号：R651.11[医药卫生—外科学]