扩大经鼻内镜手术切除鞍结节脑膜瘤临床应用和分析  

Surgical treatment for tuberculum sellae meningiomas via extended endoscopic endonasal approach

作　　者：周跃飞 薛文[2] 贾鹏飞 袁云超 杨双武 高大宽 ZHOU Yuefei;Xue Wen;JIA Pengfei;YUAN Yunchao;YANG Shuangwu;GAO Dakuan(Department of Neurosurgery,Xijing Hospital,Air Force Medical University,Xi’an,Shaanxi 710032,China;Department of Neurosurgery,Lvliang People’s Hospital,Lvliang,Shanxi 723000,China)

机构地区：[1]空军军医大学西京医院神经外科,陕西西安710032 [2]吕梁市人民医院神经外科,山西吕梁033000

出　　处：《中华神经外科疾病研究杂志》2024年第5期30-34,共5页Chinese Journal of Neurosurgical Disease Research

基　　金：陕西省重点研发项目(2023-YBSF-170);空军军医大学临床研究项目(2023LC2333)空军军医大学第一附属医院临床研究专项(xjzt24ly23)。

摘　　要：目的总结神经内镜下经鼻扩大入路切除鞍结节脑膜瘤的安全性及有效性。方法回顾性分析2018年1月至2023年6月鼻扩大入路切除鞍结节脑膜瘤的106例患者的临床资料,总结分析其疗效、并发症和手术优越性。根据不同情况进行颅底多层重建。结果Simpson I级切除99例(93.4%),5例Ⅱ级切除,Ⅲ级切除2例,围术期死亡1例(0.9%)。头痛症状明显缓解41例(41/47,87.2%),视力明显改善39例(39/53,73.6%)。术后共15例(14.0%)出现并发症,其中3例(2.8%)出现脑脊液鼻漏行二次修补手术;5例(4.7%)单纯颅内感染,4例(3.8%)出现视力损害,1例(0.9%)术区出血,1例(0.9%)出现短暂性尿崩症,新发1例(0.9%)出现垂体功能低下,所有患者术后随访6-72个月无复发。结论神经内镜下经鼻扩大入路切除鞍结节脑膜瘤对提高患者手术疗效具有重要意义,具有手术创伤小、手术时间短及可达SimpsonⅠ级切除的优点,是一种理想的手术入路,临床应用前景好。经鼻内镜并不适合所有鞍结节脑膜瘤,需严格把握手术指征。Objective To summarize the safety and efficacy of extended endoscopic endonasal approach for tuberculum sellae meningioma resection.Methods The clinical data of 106 patients of tuberculum sellae meningioma who underwent extended endoscopic endonasal approach from January 2018 to June 2023 were retrospectively analyzed,and the efficacy,complications and surgical superiority were also summarized and analyzed retrospectively.The multilayered reconstruction technique was used according to different procedures.Results There were 99 cases(93.4%)of SimpsonⅠresection,5 cases of gradeⅡresection,2 cases of gradeⅢresection,and 1 case(0.9%)of perioperative death.Headache symptoms were relieved in 41 cases(41/47,87.2%),visual acuity was improved in 39 cases(39/53,73.6%).A total of 15 cases(14.0%)had complications after operation,including 3 cases(2.8%)of cerebrospinal fluid rhinorrhea,re-operation repair administered;5 cases(4.7%)of simple intracranial infection,4 cases(3.8%)of visual impairment,1 case(0.9%)of bleeding in surgical area,1 case(0.9%)of transient diabetes insipidus,and 1 new case(0.9%)of hypopituitarism.All patients had no recurrence within the 6-72 months of following-up after surgery.Conclusions Extended endoscopic endonasal approach is an option for the surgical treatment of tuberculum sellae meningioma because of its minimal invasion,shorter surgical time and achievement of Simpson grade I resections in selected patients,but is not suitable for all tuberculum sellae meningiomas,and should be applied under strict surgical indication.

关 键 词：鞍结节脑膜瘤 扩大经鼻内镜 脑脊液漏 颅底重建 

分 类 号：R739.45[医药卫生—肿瘤]