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目的探讨经鼻内镜在颅底占位性病变手术中的应用。方法回顾性分析2000年6月至2006年9月42例颅底占位性病变患者的临床资料。其中前、中颅底恶性肿瘤13例,脊索瘤8例,侵袭性垂体瘤向蝶窦、蝶鞍颅底破坏者5例,蝶骨骨纤维异样增殖症4例,翼腭窝、颞下窝神经纤维瘤3例,纤维血管瘤3例,前、中颅底骨化纤维瘤3例,其他病变3例。结果 42例患者中,肿瘤完全切除36例,病变次全切除6例,2例因出血过多分两次完成手术,其余病变均1次完全切除。术后l例患者右眼失明,1例患者出现脑脊液耳漏,保守治疗1周后痊愈。42例均进行随访,随访6～81个月,其中5例失访,8例复发,6例死亡,其余患者未见复发。结论内镜下颅底占位性病变外科手术治疗安全、有效、微创,但需根据一定的技术、设备条件,严格掌握手术适应证。
Objective To investigate the application of endoscopic nasal endoscopy in space occupying lesions of skull base. Methods The clinical data of 42 patients with space occupying skull base from June 2000 to September 2006 were retrospectively analyzed. Among them, before and in the skull base tumor in 13 cases, 8 cases of chordoma, invasive pituitary tumor to sphenoid sinus, 5 cases of sella skull base damage, sphenoid bone fibrosis in 4 cases, pterygopalatine fossa, 3 cases of neurofibroma, 3 cases of fibrosarcoma, 3 cases of anterior and middle skull ossifying fibroma and 3 cases of other lesions. Results Of the 42 patients, 36 were completely resected, 6 were subtotally removed, 2 were completely surgically treated twice due to excessive bleeding, and 1 was completely resected in the remaining lesions. One patient had blindness in the right eye and one patient had cerebrospinal fluid otorrhea after one week of conservative treatment. Forty-two patients were followed up for 6 to 81 months. Five patients were lost to follow-up, 8 patients relapsed and 6 patients died. No recurrence occurred in the other patients. Conclusion Surgical operation of endoscopic skull base occupying lesions is safe, effective and minimally invasive. However, surgical indications should be strictly controlled according to certain technical and equipment conditions.