颅咽管瘤的内镜经鼻手术治疗  

Endoscopic transnasal surgery for craniopharyngiomas

作　　者：桂松柏[1] GUI Songbai(Neurosurgery Department,Beijing Tiantan Hospital,Capital Medical University,Beijing 100000,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100000

出　　处：《中华神经外科疾病研究杂志》2025年第1期1-4,共4页Chinese Journal of Neurosurgical Disease Research

基　　金：首都临床诊疗技术研究及示范应用协同创新重点项目(Z191100006619087)。

摘　　要：颅咽管瘤位于颅底中央的核心区域,生长方式及解剖位置多样,毗邻重要神经、血管、脑干、下丘脑,导致颅咽管瘤的手术治疗一直是神经外科面临的重大挑战。随着内镜颅底外科手术技术、设备、器械的快速进步,以及手术经验的不断积累,内镜经鼻治疗颅咽管瘤的手术技术亦不断提高,从早期切除鞍内型颅咽管瘤,进展到目前可以切除侵袭鞍上、第三脑室的颅咽管瘤;从能够完成成人颅咽管瘤的内镜经鼻切除,进展到可以完成幼儿和儿童颅咽管瘤的内镜经鼻切除。其主要优势是:手术角度符合颅咽管瘤的生长方向,可以抵近观察,无视觉盲区及死角,能够直视下分离肿瘤和周边的重要结构,从而可以减小手术损伤、增加肿瘤全切几率,有效提高颅咽管瘤的手术切除质量。目前,绝大多数幼儿、儿童、成人颅咽管瘤应该首选内镜经鼻手术治疗。Located in the central core region of the skull base,with diverse growth patterns and anatomical positions,craniopharyngiomas are adjacent to critical nerves,blood vessels,the brainstem,and the hypothalamus,making surgical treatment a significant challenge to neurosurgeons.With the rapid advancements in endoscopic skull base surgery techniques,equipment,and instruments,as well as the continuous accumulation of surgical experience,the surgical techniques of endonasal endoscopic treatment for craniopharyngioma have been continuously improved,from resection of intrasellar craniopharyngioma at early stage to removal of craniopharyngioma invading suprasellar and third ventricle.More importantly,this approach has also evolved from being only applicable to resection of craniopharyngiomas in adults to being suitable for infants and children as well.This technique naturally possesses plenty of advantages,including the operational angle aligned with the growth direction of craniopharyngioma,the possibility of close observation to eliminate blind spots and dead corners,and the capability of separating the tumor from the surrounding critical structures under direct vision.These traits contribute to reducing surgical injury,increasing total resection rate,and finally,improving the surgical quality of craniopharyngioma effectively.At present,the endonasal endoscopic approach should be the preferred treatment strategy for most infants,children,and adults with craniopharyngiomas.

关 键 词：颅咽管瘤 内镜经鼻入路 

分 类 号：R739.41[医药卫生—肿瘤]