摘要
目的探讨神经内镜经鼻入路手术治疗颅咽管瘤的临床疗效。方法回顾性分析2018年10月至2020年4月首都医科大学附属北京天坛医院神经外科采用神经内镜经鼻入路治疗102例颅咽管瘤患者的临床资料,其中原发肿瘤82例,复发肿瘤20例。术后每3个月门诊随访患者的视力、视野,评估垂体-靶腺轴损伤数量以及有无尿崩症,复查头颅MRI观察肿瘤有无复发、进展。根据术后3个月的头颅MRI结果,评估肿瘤的切除程度结果102例患者中,92例(90.2%)肿瘤全切除,10例(9.8%)次全切除;其中原发肿瘤全切除77例,复发肿瘤全切除15例术后5例患者发生脑脊液漏并行神经内镜经鼻修补术,3例患者发生中枢神经系统感染。无一例患者死亡或出现昏迷。102例患者随访时间的中位数(范围)为12(6~19)个月。至末次随访,96例术前视力、视野受损的患者中,62例视力明显改善,27例稳定,7例恶化;术前视力正常的6例患者中,仅1例术后视力短暂下降,术后3个月复查时视力恢复正常。99例合并尿崩症,其中72例尿崩症持续时间≤3个月,27例持续时间>3个月至末次随访,73例术前存在垂体-靶腺轴功能障碍的患者,垂体-靶腺轴功能均无改善;29例术前垂体-靶腺轴功能正常的患者中,22例出现垂体-靶腺轴功能障碍102例患者随访期间复查头颅MRI均未见肿瘤复发或进展。结论采用神经内镜经鼻入路手术可更充分地观察肿瘤与视神经、垂体柄及下丘脑等结构的界限,为术者提供更清晰的术野,肿瘤全切除率较高,部分患者术后视力、视野改善,但术后尿崩症和垂体-靶腺轴功能障碍发生率较高。
Objective To investigate the clinical effect of neuroendoscopic transnasal approach in the treatment of craniophaiyngiomas.Methods A retrosjactive analysis was conducted on the clinical data of 102 patients with craniopharyngiomas who underwent treatment through endoscopic endonasal approacli from October 2018 to April 2020 at Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University.There were 82 patients with primarv tumors and 20 patients with recurrent tumors.The visual acuity and visual field of the patients were followed up even 3 months.The visual acuity,visual field,the number of pituitary target gland axis injuries and diabetes insipidus were evaluated.Hie head MRI was reviewed to identify the recurrence and progression of tumor.The degree of tumor resection was evaluated according to the results of MRI at 3 months after operation.Results Of the 102 patients,92(90.2%)underwent total tumor resection and 10(9.8%)underwent subtotal resection.77 patients with primary tunwrs and 15 patients with recurrent tumors underwent total tumor resection.There were 5 cases of cerebrospinal fluid leakage and endoscopic nasal repair and 3 cases of infection of the central nervous system.There was no death or conia.The follow-up time of 102 patients was 12(6-19)months.At the last follow-up,among 96 patients with impaired visual acuity and visual field before operation,62 cases had significant improvement,27 cases had stable vision,and 7 cases reported deterioration;among 6 cases with normal preoperative vision,only 1 case had short-term postoperative visual loss,and the visual acuity returned to normal at 3 months after operation.There were 99 cases which were complicated with diabetes insipidus,of which 72 cases had a duration of ≤3 months and 27 cases had a duration of >3 months.At the latest follow-up,there were 73 patients with preoperative pituitary target axis dysfunction who had no improvement after surgerv;Of the patients with preoperative normal function of pituitary target axis,22 reported
作者
马国佛
李储忠
白吉伟
赵澎
曹磊
王新生
张亚卓
桂松柏
Ma Guofo;Li Chuzhong;Bai Jiwei;Zhao Peng;Cao Lei;Wang Xinsheng;Zhang Yazhuo;Gui Songbai(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2021年第2期123-127,共5页
Chinese Journal of Neurosurgery
基金
北京市科学技术委员会资助项目(Z19110700660000)。
关键词
颅咽管瘤
自然腔道内镜手术
治疗结果
手术后并发症
内分泌系统
Craniopharyngioma
Natural orifice endoscopic surgery
Treatment outcome
Postoperative complications
Endocrine system
