摘要目的 报道应用扩大经蝶入路治疗斜坡脊索瘤的临床效果.方法 采用扩大经蝶入路显微手术切除斜坡脊索瘤病例9例(均经病理结果证实),所有病例均在神经导航下进行,其中经唇下-扩大经蝶入路4例,经鼻-扩大经蝶入路5例.4例术前通过虚拟现实系统实现图像三维重建,明确肿瘤与周围重要结构的关系,以更好的指导手术入路.结果 肿瘤术中显微镜下及术后影像学证实完全切除3例,肿瘤镜下次全切除(切除比例大于90%)6例.其中2例因肿瘤侵犯至硬脑膜下,肿瘤切除后出现脑脊液漏,经颅底重建修补后痊愈.结论 扩大经蝶入路显微手术可以简单迅速地到达斜坡区域,并能较充分地暴露前颅底、中下斜坡以及双侧海绵窦区,术后并发症少,创伤小,对斜坡脊索瘤来讲是一种较好的手术方式.

abstractsObjective To evaluate the application of microscopic extended transsphenoidal approach in surgery for clival chordomas. Methods Nine patients with clival chordomas were managed by microscopic extended transsphenoidal approach from August 2007 to March 2008 with the assistance of neuro-navigation. Among those, 3-D stereoscopic virtual reality images of 4 cases were reconstructed successfully,which could identify the relationship between the tumors and surrounding structures and conduced to the operations. Results Total removal was achieved in 3 cases,which was confirmed by the imaging-scopy after the operations, subtotal removal in 6 cases. Because of the invasion of the subdural space by the tumor,CSF leakage occurred in 2 cases after the tumors were removed, which was cured by the reconstruction of the cranial base with the fat tissue and albumin gel. Conclusion The microscopic extended trans spbenoidal approach is a viable, minimally invasive alternative for surgical treatment of clival tumors. By this approach, the clivus including the anterior skull base and cavernous sinus can be exposed conveniently.