额底纵裂入路修补前颅底技术在治疗颅咽管瘤中的应用

目的探讨额底纵裂入路联合鞍结节磨除并行显微缝合修补前颅底技术在治疗颅咽管瘤中的应用。方法回顾性分析2017年1月—2022年1月首都医科大学三博脑科医院神经外科治疗的30例累及鞍内的颅咽管瘤患者临床资料，并结合相关文献进行复习。结果原发肿瘤13例，复发肿瘤17例，肿瘤平均直径为3.3 cm。术后所有肿瘤均完全切除。术后出现1例脑脊液漏合并颅内感染患者，术后4个月死亡。其余29例患者均未出现脑脊液鼻漏及颅内感染。术后平均随访3.9年，30例患者随访期间均未复发。29例患者均回归日常生活。结论额底纵裂入路联合鞍结节磨除能够有效地切除累及鞍内区域的颅咽管瘤，通过显微缝合修补前颅底缺损能够有效减少术后脑脊液漏的风险。

Objective To explore application of frontal basal interhemispheric approach combined with tuberculum sellae drilling and microsurgical suture repair of anterior skull base defect in the treatment of craniopharyngioma. Methods The clinical data of 30 patients with craniopharyngioma involved in the sella treated by Sanbo Brain Hospital, Capital Medical University from January 2017 to January 2022 were analyzed retrospectively. The relevant literature was reviewed. Results Of 30 patients, there were 13 primary tumors and 17 recurrent tumors. The average diameter of the tumor was 3.3 cm. All tumors were completely removed after operation. One case of cerebrospinal fluid leakage and intracranial infection occurred. 4 months after operation, the patient died for sudden death. The other 29 patients had no cerebrospinal fluid leakage and intracranial infection. The average follow-up was 3.9 years, ranging from 0.5 to 5.4 years. 30 patients did not recur during follow-up and 29 returned to daily life. Conclusions The frontal basal interhemispheric approach combined with tuberculum sellae removal can effectively remove craniopharyngiomas involving the intrasellar region. The repair of anterior skull base defect by microsurgical suture can effectively reduce the risk of cerebrospinal fluid leakage.