经颅和内窥镜经鼻联合入路治疗颅内交通肿瘤的临床疗效。

Neuro endocrinology letters Pub Date : 2023-09-29
Zhi-Jian Xu, Qi Tu, Hua-Hui Chen, Fan Yang, Min-Feng Tong, Binhua Lu
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引用次数: 0

摘要

背景:颅交通肿瘤通常起源于轴外颅内组织、鼻腔和鼻窦,大多侵犯前颅底,导致颅骨和鼻腔之间的交通。颅交通肿瘤在临床上是罕见的,因此在文献中很少报道。目的:探讨经颅和内窥镜经鼻联合入路治疗颅鼻交通肿瘤的临床疗效。方法:回顾性分析2017年7月至2020年3月在浙江大学附属金华医院神经外科接受治疗的颅鼻交通肿瘤患者。所有患者均采用经颅和内窥镜经鼻联合入路或颅鼻双入路进行手术治疗,同时进行颅底重建。评估术后肿瘤总切除率、围手术期并发症和术后疗效。结果:纳入11例患者,随访时间为14-37个月。8名患者接受了全切除,2名患者接受次全切除,1名患者接受部分切除治疗。术后病理诊断显示4例嗅觉神经母细胞瘤、3例非典型脑膜瘤、2例复发性乳头状瘤恶性肿瘤、1例复发性侵袭性垂体瘤和1例复发侵袭性垂体腺癌。在11名患者中,有一名患者术后出现严重脑水肿,并进行了颅骨减压切除术。在两名患者中观察到颅内感染,其中一名患者出现短暂性脑脊液漏,经症状治疗后治愈。此外,一名和两名患者分别出现术后眼部运动障碍和嗅觉不良。11例患者的平均随访时间为(24.4±5.7)个月。患者一年生存率为100%;10名患者(90.9%)的预后良好(格拉斯哥预后量表评分为4-5),只有一名患者(9.1%)的格拉斯哥预后量图评分为3。此外,在最后一次随访中,有两名患者(18.2%)发生了肿瘤复发。结论:采用颅鼻双入路和颅底重建同时手术治疗颅鼻交通肿瘤,提高了肿瘤总切除率,术后并发症较少,短期疗效良好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical Outcomes of Combined Transcranial and Endoscopic Transnasal Approaches in the Management of Cranionasal Communicating Tumors.

Background: Cranionasal communicating tumors often originate from the extra-axial intracranial tissue, nasal cavity, and sinuses, and mostly invade the anterior skull base, leading to communication between the cranial and nasal cavities. Cranionasal communicating tumors are clinically rare and thus have been rarely reported in the literature.

Objective: To investigate the clinical outcomes of combined transcranial and endoscopic transnasal approaches in the surgical management of cranionasal communicating tumors.

Methods: We retrospectively analyzed patients with cranionasal communicating tumors treated at the Department of Neurosurgery, Jinhua Hospital, affiliated with Zhejiang University, from July 2017 to March 2020. All patients were surgically treated using combined transcranial and endoscopic transnasal approaches or the cranionasal dual approach, and skull base reconstruction was performed simultaneously. The postoperative gross tumor resection rate, perioperative complications, and postoperative efficacy were evaluated.

Results: Eleven patients with 14-37 months of follow-up were included. Eight patients underwent total resection, two patients underwent subtotal resection, and one patient was treated with partial resection. Postoperative pathological diagnoses revealed four olfactory neuroblastomas, three atypical meningiomas, two recurrent papilloma malignancies, one recurrent invasive pituitary tumor, and one recurrent invasive pituitary adenocarcinoma. Among the 11 patients, severe cerebral edema was observed postoperatively in one patient, and decompression craniectomy was performed. Intracranial infection was observed in two patients, including one with transient cerebrospinal fluid leakage, which was cured after symptomatic treatment. Moreover, postoperative ocular dysmotility and worse olfactory sensation were observed in one and two patients, respectively. The mean follow-up time of the 11 patients was (24.4 ± 5.7) months. The one-year survival rate of the patients was 100%; 10 patients (90.9%) had a favorable outcome (Glasgow Outcome Scale score of 4-5), and only one patient (9.1%) had a Glasgow Outcome Scale score of 3. Furthermore, during the last follow-up, tumor recurrence occurred in two patients (18.2%).

Conclusion: Surgical treatment of cranionasal communicating tumors using the cranionasal dual approach and simultaneous skull base reconstruction improves the gross tumor resection rate with fewer postoperative complications and good short-term efficacy.

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