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目的探讨鼻内镜下经口咽入路处理颅颈交界区腹侧病变的手术方法及临床效果。方法回顾性总结2002年8月至2006年11月16例颅颈交界区腹侧病变的患者行鼻内镜下经口咽入路手术资料,其中斜坡脊索瘤6例,寰枕畸形5例,颅底凹陷症合并 Chiari 畸形3例,齿状突骨折2例。用0°鼻内镜行中下斜坡区手术,30°鼻内镜行颅颈畸形手术。结果 16例患者均进行2～48个月随访,术后患者临床症状均有所改善。其中6例脊索瘤患者中,1例术后6个月复发并死亡,1例术后7个月复发,1年术后2年复发,均再次手术治疗,余3例至今未复发。8例颅颈畸形患者症状均有所改善,其中1例术后行后入路钢板固定,1例颅底凹陷症合并 Chiari 畸形的患者术后行后颅窝减压。结论颅颈交界处病变采用鼻内镜下经口咽入路方法直接、术野清晰、微创、操作空间大、疗效满意。
Objective To investigate the surgical methods and clinical effects of transoral approach for the treatment of ventral lesions in craniocervical junctional area under endoscopic sinus surgery. Methods From August 2002 to November 2006, 16 cases of ventral lesions in the craniocervical junctional area underwent endoscopic oro-pharyngeal approach. Among them, 6 were chordoma, 5 were atlanto-occipital deformity, 3 cases of skull base depression complicated with Chiari deformity and 2 cases of odontoid fracture. With 0 ° endoscopic sinus surgery in the lower slope, 30 ° endoscopic craniocerebral surgery. Results All the 16 patients were followed up for 2 ~ 48 months. The clinical symptoms of patients were improved after operation. One of 6 patients with chordoma recurred and died 6 months after surgery, 1 patient recurred 7 months after operation, 1 year after operation 2 years recurrence, were re-operation, the remaining 3 cases have not relapsed. The symptoms of 8 patients with craniocerebral deformity were improved. Among them, 1 patient was fixed with posterior approach and 1 patient with skull base depression complicated with Chiari malformation was treated with posterior fossa decompression. Conclusions The lesions of the craniocervical junction were treated by endoscopic oro-pharyngeal approach directly. The operative field was clear and minimally invasive. The operating space was large and the curative effect was satisfactory.