神经内镜经鼻治疗颅底良恶性肿瘤的临床体会

摘要

目的 总结神经内镜经鼻治疗颅底肿瘤的手术技巧和治疗经验.方法 2014年8月—2016年12月我科治疗的眶区、鞍区、斜坡、翼腭窝、颞下窝的良、恶性肿瘤患者共8例,均采取神经内镜经鼻手术,手术涉及视神经减压、颈内动脉、中颅底斜坡硬脑膜肿瘤的处理、翼腭窝颞下窝开放等,术后对硬脑膜颈内动脉暴露的抗感染、抗炎处理,针对复视、视力下降的眼科治疗,垂体激素的调整等相关并发症的处理.结果 1例真菌性鼻窦炎患者术后1周视力由无光感恢复至"指数/1m";2例垂体瘤患者术后出现一侧眼球外展受限,经治疗1周后恢复;1例侵袭性垂体瘤术后出现尿崩症,对症治疗半个月后尿量及比重趋于正常.2例腺样囊性癌患者在术后10 d、3个月、1年行增强磁共振检查均达到术中全切及术后无局部复发.1例鼻咽癌患者术后达到全切,随访半年未见局部复发.8例患者均未出现严重并发症.结论 神经内镜经鼻手术是处理颅底肿瘤的重要手段,需要有丰富的手术经验和临床科室的共同协作.%Objective To summarize the surgical skills and experience of skull base surgery by endoscopic treatment. Methods A total of 8 cases with benign and malignant tumors were treated in our hospital from August 2014 to December 2016, including orbital region, sellar region, clivus, pterygopalatine fossa and infratemporal fossa. The endoscopic endonasal surgery involved optic nerve decompression, internal carotid artery, treatment of middle skull base and clivus dura tumors, opening of pterygopalatine fossa and infratemporal fossa. The anti infection and anti inflammation treatment of the dura and the internal carotid artery and the treatment of the complications such as diplopia, vision decrease, and the adjustment of pituitary hormones were given to patients after operation. Results The visual of a patient with fungal sinusitis recovered from no light perception to "finger/1 m" at one week after surgery. One of the patients with pituitary tumor underwent unilateral eyeball abduction limitation. The symptoms disappeared after one week treatment. Insipidus occurred in 1 patient with invasive pituitary adenoma, after symptomatic treatment for half a month, urine volume and specific gravity tend to normal. Two patients with adenoid cystic carcinoma underwent enhanced MRI examination at 10 days, 3 months and 1 year after operation, both achieved total resection and no local recurrence. The patient with nasopharyngeal carcinoma reached total resection after operation, and showed no local recurrence after six-month follow-up. All the 8 patients achieved complete resection in one stage, without any serious complication after operation. Conclusion Endoscopic endonasal surgery is an important method for the treatment of tumour in anterior skull base, which needs extensive surgical experience and cooperation with other clinical departments.