经鼻腔去除脑部恶性肿瘤新方案

一种侵袭性很小去除脑部肿瘤的新方案具有没有伤痕、住院时间较短、并发症较少的特点。
 
美国Rush大学医学中心的外科医生使用一种经鼻到脑的技术，这种技术能成功去除垂体肿瘤。微型手术器械、改良的内镜成像、计算机指导的手术向导以及膜密封剂等众多元素的结合使这种通过硬脊膜安全到达肿瘤部位的技术成为可能。该治疗方案同时减少了脑脊液漏出、头痛、感染、脑膜炎等并发症的危险。

经计算机定位系统和内镜指导，外科医生在鼻子的后方的骨头上钻几个小孔并穿过硬脊膜。通过图像在屏幕上放大，外科医生可以清晰看到微型外科器材的方位。肿瘤通过鼻孔完全取出。为了完成整个手术，硬脊膜上的小孔必须完全密封防止脑脊液漏出。外科医生使用来源于尸体皮肤的材料构建一个支架。几层这种材料加上从来源于病人的脂肪堵住这些孔洞，这些材料随后会延展并把孔洞密封起来。

“而开放性手术，我们必须移开肿瘤周围的脑部组织。使用上述经鼻的新方案不会造成脑部的损伤。” Rush大学神经外科主任Richard Byrne说。“按照这种方案可以获得与开放手术相同的效果并且不会对脑部造成太大的影响。”

但这种经鼻方案并不适用于所有的脑部肿瘤；它可用来治疗大多数头颅肿瘤、头骨连接部的肿瘤以及鼻部和脊椎的肿瘤。施行这种方案必须通过具有经验的神经外科医生和头颈部外科医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.