颅内外沟通性嗅神经母细胞瘤8例显微手术治疗分析

Microsurgical treatment of intracranial and extracranial communicative olfactory neuroblastoma in 8 cases

摘要:

目的讨论颅内外沟通性嗅神经母细胞瘤（ONB）的临床特点及显微手术策略。 方法湘雅医院神经外科2013年1月—2019年6月收治的颅内外沟通性ONB患者8例，男5例，女3例，年龄13~65岁；病程7 d至5年，平均12个月。其中手术选择双侧扩大经额底入路5例，联合经鼻内镜3例。全部患者术后行放疗，2例辅助化疗。观察患者的手术策略和临床疗效。结果8例患者颅内外沟通性ONB全切除，术后头痛及鼻腔疼痛全部改善，随访7个月至6年，存活4例，失访2例，2例术后4~10个月肿瘤广泛复发导致死亡。结论双侧扩大经额底入路及联合经鼻内镜显微手术有助于颅内外沟通性ONB的全切除，可提高患者生存率，值得临床推广。

关键词:嗅神经母细胞瘤|鼻|颅底外科|手术|治疗

Abstract:

Abstract:ObjectiveTo summarize the clinical characteristics of and microsurgical treatment strategies for intracranial and extracranial communicative olfactory neuroblastoma.MethodsEight patients suffering from intracranial and extracranial communicative olfactory neuroblastoma were surgically treated in our department between Jan 2013 and July 2019. Of them, five were male and 3 were female with age ranged from 13 to 65 years old and disease course from 7 days to 5 years. Microsurgical treatment was performed via extendend bilateral transfrontal approach in 5 and endoscopeassisted transnasal approach in 3. All patients received postoperative radiotherapy, and 2 received adjuvant chemotherapy. The clinical characteristics of and microsurgical treatment strategies for this tumor were analyzed.ResultsTotal tumor resection was achieved in all 8 patients with alleviation of headache and nasal pain. Followed up for 7 months to 6 years, 4 patients survived, 2 lost contact, and 2 died from extensive tumor recurrence in 4 to 10 months after surgery.ConclusionBoth extendend bilateral transfrontal approach and endoscopeassisted transnasal approach benefit total resection of intracranial and extracranial communicative olfactory neuroblastoma and increase the cure rate, and therefore are worthy of clinical promotion.

Key words:Olfactory neuroblastoma|Nose|skull base surgery|Surgery|Treatment