目的:以前认为鞍周肿瘤和颅内动脉瘤共存是一种罕见的现象。在这项研究中,我们介绍了我们在手术策略方面的经验,以治疗这种并存的病理。
方法:这项回顾性研究回顾了2017年11月至2022年10月,鞍周肿瘤和动脉瘤并存病理患者的病历和术中视频。
结果:我们的研究涉及20名患者,包括9名男性和11名女性。三名患者选择了单阶段EEA,包括患有MP型三叉神经鞘瘤并伴有前交通动脉瘤的患者,一个患有多形性黄色星形细胞瘤,伴有左ICA突旁动脉瘤,一个患有复发性垂体腺瘤并伴有右ICA突旁动脉瘤。13例患者首先通过EEA选择了肿瘤切除术,并进行了栓塞或动脉瘤保留。也有2例不规则形状的动脉瘤患者在肿瘤切除前选择了栓塞。所有肿瘤都被完全切除,只有少数患者经历复发和术后并发症,动脉瘤的随访也很稳定。还有两名患者选择保守治疗肿瘤和动脉瘤,但不幸的是,其中一人患有动脉瘤破裂,最终死亡。没有脑脊液鼻漏,所有患者均发现严重颅内感染或手术相关出血.
结论:动脉瘤的分期手术或保守治疗可以被认为是治疗共存病变的安全有效的策略。然而,在非常有选择的情况下,单级EEA可用作此类共存病理的综合治疗的一部分。
The coexistence of perisellar tumors and intracranial aneurysms was previously considered a rare phenomenon. In this study, we introduce our experience with surgical strategies for the treatment of such coexisting pathologies.
This retrospective study reviews the medical records and intraoperative videos of patients with coexisting pathologies of perisellar tumors and aneurysms from Nov 2017 to Oct 2022.
Our study involved 20 patients, including 9 males and 11 females. Three patients selected the single-stage endoscopic endonasal approach (EEA), including one with a type of MP trigeminal schwannoma with an anterior communicating aneurysm, 1 with a pleomorphic xanthoastrocytoma with a left internal carotid artery paraclinoid aneurysm, and 1 with a recurrent pituitary adenoma with a right internal carotid artery paraclinoid aneurysm. Thirteen patients chose tumor resection first through the EEA with embolization or aneurysm conservation. There were also 2 patients with irregularly shaped aneurysms who chose embolization before tumor resection. All tumors were completely removed, with only a few patients experiencing recurrence and postoperative complications, and the follow-up of the aneurysms was also stable. There were also 2 patients who chose conservative management for both tumors and aneurysms, but unfortunately, one of them suffered from aneurysm rupture and eventually died. No cerebrospinal fluid rhinorrhea, severe intracranial infection, or surgical-related hemorrhage was found in any patients.
Staged surgery or conservative treatment for aneurysms can be considered a safe and effective strategy for the treatment of coexisting pathologies. However, in very selected cases, the single-stage EEA can be used as part of a comprehensive treatment for such coexisting pathologies.