神经内镜手术治疗颅底脊索瘤30例临床分析

Clinical analysis of neuroendoscopic surgery for skull base chordoma in 30 patients

摘要:

目的探讨采用神经内镜治疗颅底脊索瘤的治疗方法及效果。方法回顾性分析2014年1月~2019年1月入住我科，并接受神经内镜手术治疗的30例颅底脊索瘤患者的临床资料，包括临床表现、影像学特点、手术入路的选择、术中要点及并发症等。结果30例患者共进行了34次手术，肿瘤全切16例17台次（16/30，53.3%），次全切除8例8台次（8/30，26.7%），大部切除6例9台次（6/30，20%）。1例围术期感染死亡。术后临床症状缓解者25例（25/30，80%），无明显改善者4例（4/30，13.3%），加重1例（1/30，3.3%），出现新发神经功能障碍2例（2/30，6.7%）。13例患者行术后辅助放疗，包括适形放疗6例，γ刀4例，质子刀3例。25例患者获得随访，18例患者术后肿瘤无进展（18/25，72%），无进展生存期（PFS）范围为6~50个月，平均15.7个月。肿瘤复发7例（7/25，28%），无进展生存期范围5~39个月，平均14.1个月，2例患者死于继发肺部感染。13例行术后放疗的患者中，有2例复发；12例单纯行手术患者中，有5例复发。对比两组患者生存曲线，术后放疗组无瘤生存期明显好于单纯手术组，两组比较有统计学意义（P=0.038）。结论神经内镜手术切除具有视野好，抵近观察、多角度观察等特点，具有全切率高和安全性高的优势。此外，术后辅以放疗能够延长患者的无瘤生存期。

Abstract:

Abstract:ObjectiveTo analyze the therapeutic regimens and effects of neuroendoscopic surgery for skull base chordoma.MethodsClinical data of 30 patients with skull base chordoma treated with neuroendoscopic surgery in our department from Jan. 2014 to Jan. 2019 were analyzed retrospectively. The analyzed data included clinical symptoms, imaging characteristics, selection of surgical approaches, surgical essentials and complications.Results34 operations were performed in all the 30 cases. 17 gross total resections (GTR) were achieved in 16 cases (16/30, 53.3%), 8 subtotal resections (STR) in 8 (8/30, 26.7%), and 9 most part resections in 6 (6/30, 20%). One patient died of perioperative infection. The clinical symptoms were relieved in 25 cases (25/30, 80%), not significantly improved in 4 (4/30, 13.3%), and aggravated in one (1/30, 3.3%), with occurrence of new neurological dysfunction in 2 (2/30, 6.7%). Adjuvant radiotherapies were applied to 13 patients, including conformal radiotherapy in 6, gamma knife radiotherapy in 4, and proton knife radiotherapy in 3. Of the 25 cases under followup, 18 patients had no tumor progression after operation (18/25, 72%) with progressionfree survival (PFS) of 6 to 50 months (average 15.7 months). Tumor recurrence occurred in 7 cases (7/25, 28%) with PFS of 5 to 39 months (average 14.1 months). 2 patients died of secondary pulmonary infection. Tumor recurrence occurred in 2 of the 13 patients with adjuvant radiotherapy, and in 5 of the 12 patients without adjuvant radiotherapy. Comparison of the survival curves between the two groups indicated better PFS in the patients with adjuvant radiotherapy (P=0.038).ConclusionsNeuroendoscopic resection of skull base chordoma has the characteristics of wide vision, close and multiangle observation, and the advantages of high total resection rate and high safety. Postoperative adjuvant radiotherapy can prolong the tumorfree survival of patients with skull base chordoma.