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Clinical Cancer Bulletin 2022年第3期1卷 167-171页

作者： Ye GU Kai XUE Quan LIU Huankang ZHANG Hongmeng YU Department of Neurosurgery Eye&ENT HospitalFudan UniversityShanghaiChina Department of Otolaryngology Eye&ENT HospitalFudan UniversityShanghaiChina Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention Fudan UniversityShanghaiChina research units of new technologies of endoscopic surgery in skull base tumor Chinese Academy of Medical SciencesShanghaiChina

Objective Although intracranial and extracranial communicating meningiomas are uncommon in clinical settings,they pose a considerable challenge for ***,one-stage surgery should be more comprehensively explained as it is not frequently reported as a first-line *** report A 27-year-old man with a massive intracranial and extracranial communicating meningioma was admitted with nasal congestion and mild numbness on the left side of his face.A combined transcranial and endoscopic endonasal approach was performed in a single day aided by preoperative tumor *** tumor was nearly completely removed without any serious ***-up revealed the disappearance of diplopia,with the patient having a normal ***,no tumor progression was *** The combined transcranial and endoscopic endonasal approach is feasible for removing certain massive intracranial and extracranial communicating *** techniques,such as embolization,microscopic,and endoscopic manipulation,are indispensable tools for treating such cases.

关键词： meningioma transcranial approach endoscopic endonasal approach

Integration of an enhanced recovery after surgery program for patients undergoing pituitary surgery

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World Journal of Otorhinolaryngology-Head and Neck surgery 2022年第4期8卷 330-338页

作者： Stephanie Flukes llya Laufer Jennifer Cracchiolo Eliza Geer Andrew L.Lin Jess Brallier Van Tsui Anoushka Afonso Viviane Tabar Marc A.Cohen Head and Neck Service Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkNYUSA Department of Neurosurgery Memorial Sloan Kettering Cancer CenterNew YorkNYUSA Multidisciplinary Pituitary and skull base tumor Center Memorial Sloan Kettering Cancer CenterNew YorkNYUSA Department of Medicine Memorial Sloan Kettering Cancer CenterNew YorkNYUSA Department of Anesthesiology and Critical Care Medicine Memorial Sloan Kettering Cancer CenterNew YorkNYUSA

Evidence-based enhanced recovery after surgery(ERAS)programs aim to improve patient outcomes and shorten hospital *** objective of this study is to describe the development,implementation,and evolution of an ERAS protocol to optimize the perioperative management for patients undergoing endoscopic skull base surgery for pituitary tumors.A systematic review of the literature was performed,best practices were discussed with stakeholders,and institutional guidelines were established and *** performance indicators(KPI)were measured and patient-reported outcome surveys were *** ERAS protocol was introduced successfully at our *** describe the process of initiation of the program and the perioperative management of our *** demonstrated the feasibility of integration of ERAS protocols for pituitary tumors with multidisciplinary engagement,with a particular emphasis on the use of data informatics and metrics to monitor *** expect that this approach will translate to improved quality of care for these often-complex patients.

关键词： Enhanced recovery after surgery endoscopic skull base surgery Pituitary surgery Outcomes improvement

Application of endoscopic endonasal approach in skull base surgeries: summary of 1886 cases in a single center for 10 consecutive years

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Chinese Neurosurgical Journal 2020年第3期6卷 133-140页

作者： Chuzhong Li Haibo Zhu Xuyi Zong Xinsheng Wang Songbai Gui Peng Zhao Chunhui Liu Jiwei Bai Lei Cao Yazhuo Zhang Beijing Neurosurgical Institute Capital Medical UniversityBeijingChina Department of Neurosurgery Beijing Tiantan Hospital affiliated to Capital Medical UniversityBeijingChina Beijing Institute for Brain Disorders Brain tumor Center BeijingChina China National Clinical research Center for Neurological Diseases No.119 South 4th Ring West RoadFengtai DistrictBeijing 100050China

Background:Endonasal endoscopic skull base surgery has undergone rapid technological developments and is now widely performed,but its strengths and weaknesses deserve further investigation and *** study was performed to investigate the surgical indications,complications,and technical advantages and disadvantages of endonasal endoscopic skull base ***:The clinical data of 1886 endoscopic endonasal skull base surgeries performed in our ward at Beijing Tiantan Hospital from June 2006 to June 2016 were retrospectively ***:One thousand ninety-three(73.4%,1490)pituitary adenomas,54(24.9%,217)chordomas,28(80.0%,35)craniopharyngiomas,and 15(83.3%,18)meningiomas underwent total *** patients died postoperatively,both having pituitary *** postoperative complications included olfactory disorders(n=226,11.9%),postoperative cerebrospinal fluid leakage(n=78,4.1%),hypopituitarism(n=74,3.9%),diabetes insipidus(n=64,3.4%),intracranial infection(n=36,1.9%),epistaxis(n=24,1.3%),vascular injury(n=8,0.4%),optic nerve injury(n=8,0.4%),and oculomotor movement impairment(n=4,0.2%).In total,1517(80.4%)patients were followed up for 6 to 126 months(average,42.5 months)postoperatively.A total of 196(13.2%)pituitary adenomas and 13(37.1%)craniopharyngiomas recurred but no meningiomas *** recurred in 97(44.7%)patients,in whom 5-year survival rate was 65%.Conclusion:endoscopic surgery is an innovative surgical technique and the first choice for most midline extradural lesions such as chordomas,and an excellent choice for pituitary *** probably will be a good technique for many kinds of craniopharyngiomas and a common technique for most of skull base meningiomas,so the surgical indications of these cases should be chosen carefully to make good use of its respective advantages.

关键词： Complication Indication Neuroendoscopy skull base surgery Endonasal approach

Cranial nerve monitoring in endoscopic endonasal surgery of skull base tumors (observing of 23 cases)

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Chinese Neurosurgical Journal 2019年第1期5卷 21-29页

作者： A.N.Shkarubo I.V.Chernov A.A.Ogurtsova V.E.Chernov O.V.Borisov K.V.Koval D.N.Andreev Department of Neurooncology Federal State Autonomous Institution"N.N.Burdenko National Medical Research Center of Neurosurgery"of the Ministry of Health of the Russian FederationMoscowRussia Department of Neurophysiology Federal State Autonomous Institution"N.N.Burdenko National Medical Research Center of Neurosurgery"of the Ministry of Health of the Russian FederationMoscowRussia Department of Neurosurgery N.N.Burdenko Main Military Clinical Hospital of the Ministry of Defense of the Russian FederationMoscowRussia Laboratory of Molecular Human Genetics Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological AgencyMoscowRussia

Background:Preservation of anatomic integrity and function of the cranial nerves during the removal of skull base tumors is one of the most challenging procedures in endoscopic endonasal *** is possible to use intraoperative mapping and identification of the cranial nerves in order to facilitate their *** purpose of this study was to evaluate the effectiveness of intraoperative trigger electromyography in prevention of iatrogenic damage to the cranial ***:Twenty three patients with various skull base tumors(chordomas,neuromas,pituitary adenomas,meningiomas,cholesteatomas)underwent mapping and identification of cranial nerves during tumor removal using the endoscopic endonasal approach in Department of Neurooncology of Federal State Autonomous Institution"*** National Medical research Center of Neurosurgery"of the Ministry of Health of the Russian Federation from 2013 to *** the surgical interventions,mapping and identification of the cranial nerves were carried out using electromyography in triggered *** effectiveness of the method was evaluated based on a comparison with a control group(41 patients).Results:In the main group of patients,44 nerves were examined during surgery using triggered *** the study,the III,V,VI,VII,and XII cranial nerves were identified *** cranial nerve deficiency was observed in 5 patients in the study group and in 13 patients in the control *** average length of hospitalization was 9 ***:We did not receive statistically significant data supporting the fact that intraoperative identification of cranial nerves using trigger electromyography reduces the incidence of postoperative complications in the form of cranial nerve deficits(p=0.56),but the odds ratio(0.6)suggests a less frequent occurrence of complications in the study *** on our experience,the trigger electromyography methodology appears quite promising and req

关键词： Electromyography T-EMG Intraoperative cranial nerve identification endoscopic endonasal approach skull base tumor surgery

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endoscopic endonasal transclival removal of tumors of the clivus and anterior region of the posterior cranial fossa (results of surgical treatment of 140 patients)

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Chinese Neurosurgical Journal 2018年第4期4卷 219-232页

作者： Alexey N. Shkarubo Konstantin V. Koval Ilia V. Chernov Dmitry N. Andreev Alexey B. Kurnosov Andrey A. Panteleyev Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation (N.N. Burdenko NMRCN) 4-ya Tverskaya-YAmskaya street 16 Moscow Russian Federation

Background: Until recently, tumors of the clivus and the anterior region of the posterior cranial fossa were considered extremely difficult to access and often inoperable using standard transcranial approaches. With the introduction into the neurosurgical practice of minimally invasive methods utilizing endoscopic techniques, it became possible to effectively remove hard-to-reach tumors, including central tumors of the anterior region of the posterior cranial fossa. Methods: From 2008 to the present time, the inpatient institution has operated on 140 patients with various tumors of the base of the skull, localized to the clivus and anterior region of the posterior cranial fossa (65 men and 75 women). The age of patients ranged from 3 to 74 years. tumor distribution according to the histopathological features was as follows: chordomas, 103 (73.57%);meningiomas, 12 (8.57%);pituitary adenomas, 9 (6.43%);fibrous dysplasia, 4 (2.86%);cholesteatoma, 3 (2.14%);craniopharyngiomas, 2 (1.43%);plasmacytomas, 2 (1.43%);and other tumors (giant cell tumor, neurohypophyseal glioma, osteoma, carcinoid, chondroma), 5 (3.57%). The tumors had the following size distribution: giant (more than 60 mm), 35 (25%);large (35–59 mm), 83 (59.3%);medium (21–35 mm), 21 (15%);and small (less than 20 mm), 1 (0.7%). In 11 cases, intraoperative monitoring of the cranial nerves was performed (21 cranial nerves were identified). Results: Upper, middle, and lower transclival approaches provide access to the anterior surface of the upper, middle, and lower neurovascular complexes of the posterior cranial fossa. The chordoma cases were distributed as follows according to extent of removal: total removal, 68 (66.02%);subtotal removal, 25 (24.27%);and partial removal, 10 (9.71%). The adenomas of the pituitary gland were removed totally in 6 cases, subtotally in 1 case and partially in 2 cases. The meningiomas were removed totally in 1 case, subtotally in 5 cases, and partially in 5 cases, with less than 50

关键词： Clivus Clival chordoma endoscopic endonasal transclival approach Monitoring of cranial nerves Posterior cranial fossa skull base anatomy skull base surgery

经鼻内窥镜颅底手术患儿发生脑脊液漏的危险因素（英文）

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中华神经外科疾病研究杂志 2017年第5期 401-401页

作者： Stapleton AL Tyler-Kabara EC Gardner PA Snyderman CH Wang EW Department of Otolaryngology Head and Neck surgery University of Pittsburgh Medical CenterChildren's Hospital of Pittsburgh of UPMC Department of Neurological surgery University of Pittsburgh Medical CenterChildren's Hospital of Pittsburgh of UPMC Department of Otolaryngology Head and Neck surgery University of Pittsburgh Medical CenterChildren's Hospital of Pittsburgh of UPMCUnited StatesDepartment of Neurological SurgeryUniversity of Pittsburgh Medical CenterChildren's Hospital of Pittsburgh of UPMC

OBJECTIVES To determine the risk factors associated with cerebrospinal fluid(CSF)leak following endoscopic endonasal surgery(EES)for pediatric skull base *** Retrospective chart review of pediatric patients(ages 1 month to18 years)treated for skull base lesions with EES from 1999 to *** pathologies were reviewed:craniopharyngioma,clival chordoma,pituitary adenoma,pituitary carcinoma,and Rathke’s cleft ***’s exact tests were used to evaluate the different factors to determine which had a statistically higher risk of leading to a post-operative CSF *** 55 pediatric patients were identified who underwent 70 EES’s for tumor *** the 70 surgeries,47 surgeries had intraoperative CSF leaks that were repaired at the time of surgery.11 of 47(23%)surgeries had post-operative CSF leaks that required secondary operative *** chordomas had the highest CSF leak rate at 36%.There was no statistical difference in leak rate based on the type of reconstruction,although 28%of cases that used a vascularized flap had a post-operative leak,whereas only 9%of those cases not using a vascularized flap had a *** hydrocephalus and perioperative use of a lumbar drain were not significant risk *** Pediatric patients with an intra-operative CSF leak during EES of the skull base have a high rate of post-operative CSF *** chordomas appear to be a particularly highrisk *** use of vascularized flaps and perioperative lumbar drains did not statistically decrease the rate of post-operative CSF leak.

关键词： CSF EES