一種侵襲性很小去除腦部腫瘤的新方案具有沒有傷痕、住院時間較短、并發(fā)癥較少的特點。
 
美國Rush大學(xué)醫(yī)學(xué)中心的外科醫(yī)生使用一種經(jīng)鼻到腦的技術(shù)，這種技術(shù)能成功去除垂體腫瘤。微型手術(shù)器械、改良的內(nèi)鏡成像、計算機指導(dǎo)的手術(shù)向?qū)б约澳っ芊鈩┑缺姸嘣氐慕Y(jié)合使這種通過硬脊膜安全到達腫瘤部位的技術(shù)成為可能。該治療方案同時減少了腦脊液漏出、頭痛、感染、腦膜炎等并發(fā)癥的危險。

經(jīng)計算機定位系統(tǒng)和內(nèi)鏡指導(dǎo)，外科醫(yī)生在鼻子的后方的骨頭上鉆幾個小孔并穿過硬脊膜。通過圖像在屏幕上放大，外科醫(yī)生可以清晰看到微型外科器材的方位。腫瘤通過鼻孔完全取出。為了完成整個手術(shù)，硬脊膜上的小孔必須完全密封防止腦脊液漏出。外科醫(yī)生使用來源于尸體皮膚的材料構(gòu)建一個支架。幾層這種材料加上從來源于病人的脂肪堵住這些孔洞，這些材料隨后會延展并把孔洞密封起來。

“而開放性手術(shù)，我們必須移開腫瘤周圍的腦部組織。使用上述經(jīng)鼻的新方案不會造成腦部的損傷。” Rush大學(xué)神經(jīng)外科主任Richard Byrne說。“按照這種方案可以獲得與開放手術(shù)相同的效果并且不會對腦部造成太大的影響。”

但這種經(jīng)鼻方案并不適用于所有的腦部腫瘤；它可用來治療大多數(shù)頭顱腫瘤、頭骨連接部的腫瘤以及鼻部和脊椎的腫瘤。施行這種方案必須通過具有經(jīng)驗的神經(jīng)外科醫(yī)生和頭頸部外科醫(yī)生的密切合作才能完成。

Removing Malignant Brain Tumors through the Nose

A minimally invasive approach to removing tumors in the brain offers no scars, a shorter hospital stay, and potentially fewer complications. 

Surgeons at Rush University Medical Center (Chicago, IL, USA) used the transnasal technique, which has been very successful at removing pituitary tumors, to access the brain. The confluence of miniature surgical instruments, improved endoscopic visualization, computer-guided surgical navigation, and a membrane sealant has made it possible to safely access tumors beyond the dura, reducing the danger of cerebrospinal fluid leakage that could lead to serious complications, such as severe headaches, infection, and meningitis. 

Guided by a computerized mapping system and an endoscope, surgeons drill small holes in a bone at the back of the nose and through the dura. With the camera images magnified on a screen, the surgeon can see exactly where he is threading tiny surgical instruments. The tumor is completely removed through the nostril. To complete the surgery, the hole in the dura must be completely sealed to prevent leaking of cerebrospinal fluid. The surgeons use material made from cadaver skin to create a tough scaffold. Several layers of the material along with fat harvested from the patient are placed over the hole; the material then expands to form a tight seal.
 
ith an open surgery, we have to move the brain to gain access to the tumor. With the transnasal approach, it is amazing to see the brain beautifully undisturbed,said Dr. Richard Byrne, chairman of neurosurgery at Rush.  remove the tumor with the same borders as open surgery without manipulating the brain.

The transnasal approach is not appropriate for all brain tumors; it can be used for most skull base tumors, or tumors at the junction of the cranial skeleton and the nose or spine. The procedures require close cooperation between an experienced neurosurgeon and the head and neck surgeon.