Neuroendoscopic resection of residual or recurrent sellar and clivus tumors
徐家坤 1李西西 1杨佳 1苏伟杰 1赵坤 1杨李轩 1刘凯
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作者信息
1. 中山大学附属第一医院神经外科，广州 510080
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摘要
目的 探讨神经内镜治疗复发或残余鞍区及斜坡区肿瘤的临床应用价值以及手术并发症的防治要点。 方法 回顾性收集中山大学附属第一医院神经外科自2021年11月至2023年10月采用神经内镜治疗的49例复发或残余鞍区及斜坡区肿瘤患者（垂体瘤45例、颅咽管瘤3例、斜坡区脊索瘤1例）的临床资料，总结分析其手术疗效及并发症情况。 结果 49例患者中全切除29例（59.2%）、近全切除12例（24.5%）、部分切除8例（16.3%）。2例（4.1%）患者术中出现颈内动脉破裂，予急诊行覆膜支架置入术，恢复良好出院，但其中1例遗留单侧动眼神经麻痹。术后随访1~24个月，97.2%（35/36）患者的头痛及视力下降症状好转，无一例患者出现永久性尿崩或脑脊液鼻漏等并发症；3例（6.1%）患者出现残余肿瘤增大，但肿瘤全切除患者均无复发。 结论 神经内镜治疗复发或残余鞍区及斜坡区肿瘤安全有效，但术中需重视对颈内动脉加强保护。 Objective To investigate the clinical value of neuroendoscopic resection in recurrent or residual sellar and clivus tumors and the prevention and treatment of operative complications. Methods A retrospective study was performed. Clinical data of 49 patients with residual or recurrent sellar and clivus tumors after neuroendoscopic resection in Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University from November 2021 to October 2023 were collected 45 patients were with pituitary adenoma, 3 were with craniopharyngioma, and 1 patient was with clivus chordoma their surgical efficacy and complications were summarized and analyzed. Results Total resection was achieved in 29 patients (59.2%), subtotal resection in 12 (24.5%), and partial resection in 8 (16.3%). Two patients (4.1%) had intraoperative internal carotid artery rupture and were given emergency laminar stenting, discharging with good recovery, but one of them left with unilateral motor nerve palsy. During 1-24 months of follow-up, 97.2% patients (35/36) had headache relief and visual acuity improvement, and no patient had permanent diabetes insipidus or cerebrospinal fluid rhinorrhea. Residual tumors increased in 3 patients (6.1%) no tumor recurrence after total resection was noted. Conclusion Endoscopic resection of recurrent or residual sellar and clivus tumors is safe and effective attention should be paid to the internal carotid artery during the operation.
Abstract
Objective To investigate the clinical value of neuroendoscopic resection in recurrent or residual sellar and clivus tumors and the prevention and treatment of operative complications. Methods A retrospective study was performed. Clinical data of 49 patients with residual or recurrent sellar and clivus tumors after neuroendoscopic resection in Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University from November 2021 to October 2023 were collected 45 patients were with pituitary adenoma, 3 were with craniopharyngioma, and 1 patient was with clivus chordoma their surgical efficacy and complications were summarized and analyzed. Results Total resection was achieved in 29 patients (59.2%), subtotal resection in 12 (24.5%), and partial resection in 8 (16.3%). Two patients (4.1%) had intraoperative internal carotid artery rupture and were given emergency laminar stenting, discharging with good recovery, but one of them left with unilateral motor nerve palsy. During 1-24 months of follow-up, 97.2% patients (35/36) had headache relief and visual acuity improvement, and no patient had permanent diabetes insipidus or cerebrospinal fluid rhinorrhea. Residual tumors increased in 3 patients (6.1%) no tumor recurrence after total resection was noted. Conclusion Endoscopic resection of recurrent or residual sellar and clivus tumors is safe and effective attention should be paid to the internal carotid artery during the operation.
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