2020年 · 第36卷第11期

Since 1992, Jankowski et al.^[1]Since the resection of pituitary tumors by neuroendoscopic transnasal-sphenoidal approach was reported for the first time, the technique of neuroendoscopic transnasal skull base surgery has become more and more mature, its application scope has gradually expanded, and the types of lesions treated have increased day by day. However, postoperative cerebrospinal fluid leakage has always been an important factor restricting the further development of neuroendoscopic transnasal skull base surgery. In the treatment of skull base meningioma, craniopharyngioma and other subdural tumors, the intraoperative skull base dural and bone defects are large, and the incidence of postoperative cerebrospinal fluid leakage is obviously increased. Therefore, higher requirements for skull base reconstruction technology are put forward. The increasing clinical demand has promoted the progress of skull base reconstruction technology, and a variety of new repair materials and repair technologies have been applied in clinic one after another. In 2006, the application of the vascularized nasal septal mucosal flap (Hadad-Bass-agasteguy mucosal flap)^[2]So that the incidence of cerebrospinal fluid leakage after neuroendoscopic nasal surgery was significantly reduced^[3,4,5,6,7]。

Craniopharyngioma originates from the residual epithelial tissue of the craniopharyngeal duct or Rathke sac in the embryonic stage, or from the squamous epithelium metaplasia of the original fovea, and its body is located in the anatomical space consisting of the optic nerve, optic chiasm, Willis ring, hypothalamus and pituitary gland. Because of the deep location of the tumor, the adjacent structure is important and complex, surgical treatment or radiotherapy may cause damage to important structures such as optic chiasm, pituitary stem, hypothalamus, etc. Therefore, the diagnosis and treatment of craniopharyngioma is a major challenge for neurosurgery^[1,2,3,4]。 Because drugs, radiotherapy, chemotherapy, gene immunization and other therapeutic methods are still not effective, it is still the first choice for the treatment of craniopharyngioma to surgically remove the tumor while preserving the hypothalamus-pituitary function as much as possible^[5,6,7,8]。 With the rapid development of modern medical technology, the surgical methods for craniopharyngioma are not limited to craniotomy or nasal microsurgery, and the therapeutic effect of using neuroendoscopic nasal technique to remove craniopharyngioma is more and more ideal^[9,10,11]。

Dystonia is a movement disorder characterized by abnormal movement and/or posture caused by persistent or intermittent muscle contractions, often repeated. Dystonic movements are generally patterned twisting movements that can be tremor-like. Dystonia is often induced or aggravated by voluntary movement with generalization of muscle excitation^[1]。 At present, there is no effective etiological treatment for most dystonia, and symptomatic treatment is mainly used in clinical practice. The goals of clinical treatment include reducing involuntary movements, correcting abnormal posture, reducing pain, improving function and improving the quality of life of patients. Clinically, according to the specific situation of dystonia patients, we should weigh the advantages and disadvantages, and choose comprehensive measures such as support and rehabilitation treatment, oral medication, botulinum toxin injection and surgical treatment to achieve the maximum improvement of individual function and quality of life of patients.