鼻内内镜入路治疗儿童颅咽管瘤

E. Gormolysova, V. A. Lepilin, B. Pashaev, A. Kalinovsky
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摘要

背景。颅咽管瘤在儿童颅内肿瘤中的发病率高达15%。鼻内窥镜入路(EEA)在成人颅咽管瘤切除术中应用广泛。然而,这种方法在儿科患者中仍然不常见。内镜技术显著提高了肿瘤周围结构的可见性。目的探讨应用EEA治疗小儿颅咽管瘤的可能性和局限性。材料和方法。通过俄罗斯卫生部EEA联邦神经外科中心(新西伯利亚)对5例儿童颅咽管瘤患者进行手术治疗,患者年龄4 ~ 17岁,其中男孩3例,女孩2例。所有患者术前均有不同程度的内分泌紊乱。术后视觉功能评估显示,1例患者视力改善,3例患者保持不变,1例患者视力下降。此外,我们还研究了蝶窦的体积,蝶窦的充气程度决定了肿瘤的解剖可及性。我们在小儿颅咽管瘤患者中应用EEA的经验表明,在肿瘤的大体全切除方面有积极的结果,在随访中没有肿瘤复发的数据。根据我们的结果,根据肿瘤的解剖可及性及其与关键神经血管结构的关系,可以判断鼻内内镜入路是治疗小儿颅咽管瘤的一种选择方法。内镜下鼻内切除颅咽管瘤在儿科患者可以成功地使用时,肿瘤解剖可及。在儿童颅咽管瘤的手术中使用EED的经验显示出积极的结果,包括肿瘤的高度根治性清除和在患者的进一步随访中没有复发。
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Endoscopic endonasal approach for craniopharyngiomas in children
Background. The incidence of craniopharyngiomas is up to 15 % of intracranial tumors in children. The endoscopic endonasal approach (EEA) is widely spread nowadays and especially for the craniopharyngiomas removal in adults. Nevertheless, this approach is still not so common in pediatric patients. The endoscopic technique significantly improves the visualization of the structures located around the tumor.Aim. To determine the possibilities and limitations for the use of EEA in the treatment of pediatric patients with cranio pharyngiomas.Materials and methods. A total five pediatric patients with craniopharyngiomas were operated via EEA Federal Center of Neurosurgery of Ministry of Health of Russia (Novosibirsk): the age of patients ranged from 4 to 17 years, including 3 boys and 2 girls. All patients at the preoperative stage already had endocrine disorders in one volume or another. Postoperative evaluation of the visual functions showed the improvement in one patient, three patients remained unchanged and one patient developed worthening. In addition, the volume of the sphenoid sinus was studied, the degree of pneumatization of which determines the anatomical accessibility of the tumor.Results. Our experience of the EEA for the craniopharyngiomas in pediatric patients has shown a positive result regarding to the tumor’s gross‑total removal and no data of the tumor recurrence at the follow‑up. According to our results it can be judged that endonasal endoscopic approach for the craniopharyngiomas in pediatric patients could be a method of choice based on the anatomical accessibility of the tumor and its relationships with the critical neurovascular structures.Conclusions. Endoscopic endonasal removal of craniopharyngiomas in pediatric patients can be successfully used when the tumor is anatomically accessible. The experience of using EED in surgery for craniopharyngiomas in children has shown positive results, including a high radical removal of the tumor and the absence of relapses during further follow‑up of patients.
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