摘要：

目的: 探讨内镜下经鼻入路联合显微镜下开颅手术同期切除复杂鼻颅沟通颅底肿瘤的疗效和安全性，以及血管吻合技术对颈内动脉的保护作用。方法与结果: 2020年1月至2022年12月天津市环湖医院神经外科采用内镜下经鼻入路联合显微镜下开颅手术同期治疗9例复杂鼻颅沟通颅底肿瘤患者，6例通过开颅手术中辨识、显露、移位颈内动脉的方式保护颈内动脉，3例在颈内动脉保护的基础上行颈内动脉岩骨段-桡动脉-颈内动脉床突段搭桥术。8例肿瘤全切除，1例肿瘤大部切除。术后2周，8例恢复日常生活与工作[Glasgow预后分级（GOS）5级]，1例视力减退但生活可自理（GOS分级4级）；仅1例术后3 d发生颅内感染。结论: 内镜下经鼻入路联合显微镜下开颅手术同期切除复杂鼻颅沟通颅底肿瘤疗效确切，且无严重并发症；术中颈内动脉保护及血管吻合技术的应用可有效减少术中出血及术后并发症。

关键词: 颅底肿瘤, 内窥镜检查, 神经外科手术, 颈内动脉, 脑血管重建术

Abstract:

Objective: To explore the efficacy and safety of endoscopic transnasal approach combined with microscopic craniotomy in the stimultaneous resection of complex skull base tumors with nasal cranial communication, and the protective effect of vascular anastomosis technology in the internal carotid artery (ICA). Methods and Results: From January 2020 to December 2022, the Department of Neurosurgery of Tianjin Huanhu Hospital used endoscopic transnasal approach combined with microscopic craniotomy to treat 9 patients with complex skull base tumors with nasal cranial communication at the same time, while 6 patients were protected by identifying, exposing and shifting the ICA during the craniotomy, and 3 patients underwent petrosal segment of the ICA-radial artery (RA)-bed segment of the ICA bypass on the basis of ICA protection. Among the 9 patients, 8 cases underwent total tumor resection, and one case underwent partial tumor resection; 8 cases[Glasgow Outcome Scale (GOS) level 5] resumed daily life and work at 2 weeks after surgery, one case (GOS level 4) had decreased vision on the affected side but had self- help, and only one case developed intracranial infection 3 d after surgery. Conclusions: Endoscopic transnasal approach combined with microscopic craniotomy for simultaneous resection of complex skull base tumors with nasal cranial communication has a definite therapeutic effect and no serious complications, the application of intraoperative ICA protection and vascular anastomosis technology can effectively reduce intraoperative bleeding and postoperative complications.

Key words: Skull base neoplasms, Endoscopy, Neurosurgical procedures, Carotid artery, internal, Cerebral revascularization