神经内镜经鼻-鞍结节入路与开颅手术治疗鞍结节脑膜瘤的疗效分析  

Efficacy analysis of neuroendoscopic transnasal-tuberculum sellae approach and craniotomy in the treatment of tuberculum sellae meningioma

作　　者：刘春晖[1] 李储忠[2] 朱海波[1] 耿素民[1] 曹磊[1] 李振业[1] 赵澎[1] 桂松柏[1] 张亚卓[2] Liu Chunhui;Li Chuzhong;Zhu Haibo;Geng Sumin;Cao Lei;Li Zhenye;Zhao Peng;Gui Songbai;Zhang Yazhuo(Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科学中心,北京100070 [2]首都医科大学,北京市神经外科研究所,北京100070

出　　处：《中华神经外科杂志》2023年第12期1210-1215,共6页Chinese Journal of Neurosurgery

基　　金：北京市自然科学基金(Z220012)。

摘　　要：目的对比分析神经内镜经鼻-鞍结节入路与开颅手术治疗鞍结节脑膜瘤的疗效。方法回顾性分析首都医科大学附属北京天坛医院神经外科学中心2014年1月至2018年9月行开颅手术治疗的75例Ⅰ~Ⅳ级(由本中心根据鞍结节脑膜瘤的生长特点将其分为Ⅰ~Ⅴ级)鞍结节脑膜瘤患者(开颅手术组)与2018年10月至2022年9月行神经内镜经鼻-鞍结节入路手术治疗的86例Ⅰ~Ⅳ级鞍结节脑膜瘤患者(神经内镜组)的临床资料。对比两组患者的肿瘤切除程度、视力和视野改善情况、术后并发症的发生率以及肿瘤复发率等的差异。结果两组患者手术均顺利完成。与开颅手术组比较,神经内镜组中肿瘤切除程度为Simpson分级Ⅰ级者比率较高[95.3%(82/86)对比70.7%(53/75)],术后中枢神经系统感染[1.2%(1/86)对比6.7%(5/75)]、癫痫[0(0/86)对比12.0%(9/75)]以及颅内血肿[0(0/86)对比6.7%(5/75)]的发生率较低,术后1 d出现皮质醇功能减退者[12.8%(11/86)对比21.3%(16/75)]的占比低(均P<0.05);但两组术后脑脊液漏发生率的差异无统计学意义(P=0.737)。两组比较,患者随访时间的差异无统计学意义(中位数分别为31个月、36个月,P=0.331)。与开颅手术组比较,神经内镜组术后3个月视力[61.6%(53/86)对比45.3%(34/75)]和视野[60.5%(52/86)对比42.7%(32/75)]同前或改善患者的占比高(均P<0.05),末次随访时肿瘤复发率较低[0(0/86)对比12.0%(9/75),P=0.009]。结论对于Ⅰ~Ⅳ级鞍结节脑膜瘤患者,与开颅手术比较,神经内镜经鼻-鞍结节入路手术的肿瘤切除程度Simpson分级Ⅰ级比例较高,中枢神经系统感染、癫痫和颅内血肿的发生率较低,肿瘤复发率较低。Objective To compare and analyze the efficacy of neuroendoscopic transnasal-tuberculum sellae approach and craniotomy in the treatment of tuberculum sellae meningioma.Methods A retrospective analysis was conducted on the clinical data of 75 patients with gradeⅠtoⅣsellar nodule meningiomas(craniotomy group)who underwent craniotomy treatment at Neurosurgery Center of Beijing Tiantan Hospital Affiliated to Capital Medical University from January 2014 to September 2018 and 86 patients with gradeⅠtoⅣsellar nodule meningiomas(neuroendoscopic group)who underwent endoscopic transnasal approach surgery from October 2018 to September 2022(our center classified tuberculum sellae meningiomas into gradesⅠtoⅤbased on their growth characteristics).The differences in the extent of tumor resection,improvement in visual acuity and visual field,the incidence of postoperative complications,and tumor recurrence rate between the two groups were compared.Results The operations were successfully completed in both groups.Compared with the craniotomy group,the neuroendoscopic group had a higher proportion of Simpson gradeⅠresection[95.3%(82/86)vs.70.7%(53/75)];the neuroendoscopic group had lower incidences of central nervous system infection[1.2%(1/86)vs.6.7%(5/75)],epileptic seizures[0(0/86)vs.12.0%(9/75)]and intracranial hematoma[0(0/86)vs.6.7%(5/75)]as well as lower proportion of patients with hypocortisolism on the first day after surgery[12.8%(11/86)vs.21.3%(16/75)](all P<0.05).However,there was no statistical difference in the incidence of postoperative cerebrospinal fluid leakage between the two groups(P=0.737).The patient follow-up time was not statistically significant between two groups(median:31 months and 36 months respectively,P=0.331).Compared with the craniotomy group,the neuroendoscopic group had a higher proportions of patients with the same or improved visual acuity[61.6%(53/86)vs.45.3%(34/75)]and visual field[60.5%(52/86)vs.42.7%(32/75)]at 3 months after operation.The tumor recurrence rate in the neuroendo

关 键 词：脑膜瘤 蝶鞍 自然腔道内镜手术 神经外科手术 疗效比较研究 

分 类 号：R739.45[医药卫生—肿瘤]