血流重建在神经内镜手术治疗复杂颅底肿瘤中的应用分析  

Application analysis of cerebral revascularization in endoscopic surgery of complex skull base tumors

作　　者：王序 施铭岗[2] 尚彦国[2] 于焕新[3] 马越[4] 薛凯[4] 佟小光[2] Wang Xu;Shi Minggang;Shang Yanguo;Yu Huanxin;Ma Yue;Xue Kai;Tong Xiaoguang(Clinical College of Neurology,Neurosurgery and Neurorehabilitation,Tianjin Medical University,Tianjin 300070,China;Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin 300350,China;Department of Otorhinolaryngology Head and Neck Surgery,Tianjin Huanhu Hospital,Tianjin 300350,China;Endoscopic Skull Base Surgery Center,Tianjin Huanhu Hospital,Tianjin 300350,China;Department of Neurosurgery,the People's Hospital of Anyang City,Anyang 455000,China)

机构地区：[1]天津医科大学神经内外科及神经康复临床学院,天津300070 [2]天津市环湖医院神经外科,天津300350 [3]天津市环湖医院耳鼻咽喉头颈外科,天津300350 [4]天津市环湖医院内镜颅底外科中心,天津300350 [5]河南省安阳市人民医院神经外科,安阳455000

出　　处：《中华神经外科杂志》2023年第6期583-588,共6页Chinese Journal of Neurosurgery

基　　金：天津市科委重大专项(18ZXDBSY00180)。

摘　　要：目的探讨血流重建技术在神经内镜手术治疗累及颈内动脉的复杂颅底肿瘤中的适应证及应用效果.方法回顾性分析2019年7月至2021年7月天津市环湖医院内镜颅底外科中心及神经外科采用神经内镜手术治疗的6例累及颈内动脉的复杂颅底侵袭性肿瘤患者的临床资料.其中,复发性侵袭性垂体腺瘤2例,复发性鼻咽癌、复发性斜坡软骨肉瘤、复发性颅内外沟通脑膜瘤、复发性骨化纤维瘤各1例.根据病变的侵袭范围、颈内动脉受累的特点,分别采用颈外动脉-颈内动脉搭桥术(2例)或颈内动脉-颈内动脉搭桥术(4例),完成血流重建后再行神经内镜手术切除肿瘤.术后通过门诊或电话随访,明确并发症的发生情况.术后及随访期间行头颅数字减影血管造影(DSA)或CT血管成像(CTA)以评判肿瘤切除程度和吻合血管的通畅性.结果6例患者顺利完成搭桥手术,术后即刻DSA或CTA结果均证实吻合血管通畅.肿瘤全切除4例,大部切除1例,部分切除1例.1例术前合并鼻出血的患者术后鼻出血消失.无一例出现新发神经功能障碍.1例术后出现脑脊液鼻漏,行二次手术修补后治愈.6例患者的随访时间为6~36个月,无新发缺血性卒中发生,复查CTA及DSA证实桥血管通畅.结论采用神经内镜手术治疗累及颈内动脉的复杂颅底肿瘤时,根据病变的侵袭范围、颈内动脉的受累特点选择不同的血流重建技术,有利于尽可能切除病变,降低术中大出血及术后脑缺血的风险.Objective To investigate the indications and therapeutic effect of cerebral revascularization in endoscopic treatment of complex skull base tumors involving internal carotid artery(ICA).Methods A retrospective analysis was conducted on the clinical data of 6 patients with complex aggressive tumors at skull base who underwent neuroendoscopic surgery at Endoscopic Skull Base Surgery Center and Department of Neurosurgery,Tianjin Huanhu Hospital from July 2019 to July 2021.There were 2 cases of relapsing aggressive pituitary adenoma,1 case of relapsing nasopharyngeal carcinoma,1 case of relapsing clivus chondrosarcoma,1 case of relapsing intracranial and extracranial communicating meningioma,1 case of relapsing ossifying fibroma.According to the extent of invasion and the characteristics of ICA involvement,2 cases underwent external carotid artery(ECA)-ICA bypass and 4 cases underwent ICA-ICA bypass.Neuroendoscopic surgery was performed for tumor resection after cerebral revascularization.Digital subtraction angiography(DSA)or CT angiography(CTA)was performed regularly to evaluate the degree of tumor resection and patency of anastomotic vessels.Results All 6 patients successfully underwent bypass surgery,and immediate postoperative DSA or CTA results confirmed that the anastomoses were unobstructed.Total tumor resection was achieved in 4 cases,partial resection in 1,and subtotal resection in 1.There was no new-onset neurological dysfunction.Preoperative epistaxis of 1 patient disappeared after surgery.One patient developed cerebrospinal fluid rhinorrhea after operation which was resolved after a second repair operation.The follow-up time of 6 patients ranged from 6 to 36 months,and there was no new ischemic stroke.The patency of the graft was confirmed by CTA and DSA.Conclusion When performing neuroendoscopic surgery for complex skull base tumors involving ICA,appropriate revascularization techniques should be selected according to the invasion range of the lesion and the characteristics of ICA involvement,which is c

关 键 词：颅底肿瘤 脑血管重建术 自然腔道内镜手术 治疗结果 颈内动脉 

分 类 号：R739.41[医药卫生—肿瘤]