摘要：

目的: 探讨内镜下经鼻极内侧入路切除下斜坡受累脊索瘤的经验及技术要点。方法与结果: 回顾分析郑州大学第一附属医院2022年6月至2024年6月收治的8例下斜坡受累脊索瘤患者的临床资料，均行内镜下经鼻极内侧入路肿瘤切除术及阔筋膜缝合密封+硬性颅底重建+黏膜瓣贴敷三重颅底重建术。8例患者均顺利完成手术，手术成功率为8/8。术后7 d复查影像学提示肿瘤全切除6例，次全切除2例。术后1个月3例（3/4）头痛缓解，4例（4/5）神经功能障碍缓解。手术相关并发症包括脑脊液鼻漏（2例）和颅内耐药菌感染（1例）。1例死亡，致死原因为脑脊液鼻漏合并颅内感染继发脑疝；2例复发，1例行质子放射治疗+二次手术切除，1例直接行二次手术切除。结论: 内镜下经鼻极内侧入路为全切除下斜坡受累脊索瘤提供了良好的技术手段，术中参照重要骨性标记充分显露肿瘤，可以实现有效切除。

关键词: 脊索瘤, 颅窝，后, 神经内窥镜, 鼻

Abstract:

Objective: To explore the experience and technical key points of endoscopic transnasal extreme medial approach for resection of chordoma involving the lower clivus. Methods and Results: The clinical data and follow-up data of 8 patients with chordoma involving the lower clivus admitted to The First Affiliated Hospital of Zhengzhou University from June 2022 to June 2024 were retrospectively analyzed. All patients underwent endoscopic transnasal extreme medial approach tumor resection and received triple cranial base reconstruction including fascia lata suture sealing + rigid cranial base reconstruction + mucosa flap application. All 8 patients successfully completed the surgery, with a success rate of 8/8. Postoperative 7 d imaging reexamination showed that 6 patients underwent gross total resection of tumor, and 2 patients underwent subtotal resection. At one month after surgery, the headache symptom was relieved in 3 patients (3/4), and nerve dysfunction relief was observed in 4 patients (4/5). The surgical-related complications included cerebrospinal fluid rhinorrhea (2 cases) and intracranial drug-resistant bacterial infection (one case). One death occurred, and the cause of death was brain herniation secondary to cerebrospinal fluid rhinorrhea and intracranial infection. Two recurrences occurred, and one recurrence was treated with proton radiotherapy + secondary surgical resection, while the other recurrence was treated with secondary surgical resection. Conclusions: The endoscopic transnasal extreme medial approach provides a good technical means for gross total resection of chordoma involving the lower clivus. During the operation, adequate exposure of the tumor can be achieved by referring to important bony landmarks, which can effectively resect chordoma involving the lower clivus.

Key words: Chordoma, Cranial fossa, posterior, Neuroendoscopes, Nose