ABSTRACT
Objective:To investigate the clinical value of neuroendoscopic resection in recurrent or residual sellar and clivus tumors and the prevention and treatment of operative complications.Methods:A retrospective study was performed. Clinical data of 49 patients with residual or recurrent sellar and clivus tumors after neuroendoscopic resection in Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University from November 2021 to October 2023 were collected; 45 patients were with pituitary adenoma, 3 were with craniopharyngioma, and 1 patient was with clivus chordoma; their surgical efficacy and complications were summarized and analyzed.Results:Total resection was achieved in 29 patients (59.2%), subtotal resection in 12 (24.5%), and partial resection in 8 (16.3%). Two patients (4.1%) had intraoperative internal carotid artery rupture and were given emergency laminar stenting, discharging with good recovery, but one of them left with unilateral motor nerve palsy. During 1-24 months of follow-up, 97.2% patients (35/36) had headache relief and visual acuity improvement, and no patient had permanent diabetes insipidus or cerebrospinal fluid rhinorrhea. Residual tumors increased in 3 patients (6.1%); no tumor recurrence after total resection was noted.Conclusion:Endoscopic resection of recurrent or residual sellar and clivus tumors is safe and effective; attention should be paid to the internal carotid artery during the operation.
ABSTRACT
La compleja anatomía de las estructuras vitales de la base del cráneo dificulta mucho la resección quirúrgica de los tumores que afectan esta zona. El problema fundamental de los tumores que afectan a la base del cráneo es elegir el abordaje ideal. El desarrollo inicial de la cirugía de la base del cráneo fue producto de la colaboración entre la otorrinolaringología y la neurocirugía; la participación del cirujano maxilofacial ha sido un fenómeno relativamente reciente. En este caso se presenta un abordaje transmaxilar para acceso al clivus y eliminar el tumor.
The complex anatomy exhibited by the vital structures of the skull base hinders surgical resection of tumors present in that area. The main problem when facing tumors lodged in the skull base resides in choosing the most suitable approach. The initial development of skull base surgery was a product of the collaboration between otorhinolaryngology and neurosurgery techniques. The participation of maxillofacial surgeons in these events has been a relatively recent endeavor. In the present instance a case of trans-maxillary approach to access clivus and remove a tumor was presented.