復雜難治性顱底腫瘤的精準治療進展

【摘要】 復雜難治性顱底腫瘤的治療因其解剖結構復雜、鄰近重要神經血管而充滿挑戰。近年來，隨著影像學技術、人工智能、手術方法及術后精準治療的不斷發展，顱底腫瘤的診治取得了顯著進步。本文系統綜述了術前評估、手術治療、術中精準識別和術后精準治療的最新進展。術前，多模態影像結合人工智能技術顯著提升了對腫瘤解剖結構和生物學特性的評估精度。手術方面，顯微技術與內鏡技術的結合進一步優化了手術策略，降低了手術相關風險；多學科協作模式在復雜病例中也展現了重要作用。術中，靶向熒光成像、術中導航和神經保護技術的發展有效提高了腫瘤切除率并減少了術后并發癥。術后，放射治療、靶向治療和免疫治療等精準治療策略降低了復發率、提高了侵襲性顱底腫瘤的控制率。未來，隨著精準醫學和人工智能技術的深入應用，顱底腫瘤的治療將更加個性化和高效，為患者提供更優的生存質量。

【關鍵詞】 復雜難治性顱底腫瘤；術前評估；手術治療；術中精準識別技術；術后綜合治療

【中圖分類號】 R739.41" 【文獻標志碼】 A" 【文章編號】 1672-7770（2025）01-0099-07

Advances in precision treatment of complex refractory skull base tumors

Abstract： The treatment of complex refractory skull base tumors poses significant challenges due to their intricate anatomical structures and proximity to critical neurovascular components. In recent years， advances in imaging technologies， surgical techniques， and postoperative precision therapies have led to remarkable progress in the diagnosis and management of skull base tumors. This review comprehensively summarizes recent developments in preoperative assessment， surgical treatment， intraoperative precision identification， and postoperative precision therapy. Preoperatively， multimodal imaging combined with artificial intelligence has significantly improved the accuracy of assessing the tumor's anatomical and biological characteristics. Surgically， the integration of microsurgical and endoscopic techniques has optimized strategies and reduced associated risks， with multidisciplinary collaboration proving crucial in complex cases. Intraoperatively， advancements in targeted fluorescence imaging， real-time navigation， and neuroprotection technologies have enhanced tumor resection rates while minimizing postoperative complications. Postoperatively， precision therapies such as radiotherapy， targeted therapy， and immunotherapy have notably improved control rates for recurrent and invasive skull base tumors. Looking ahead， the deeper application of precision medicine and artificial intelligence is expected to make the treatment of skull base tumors increasingly personalized and efficient， providing patients with better survival outcomes and quality of life.

Key words： complex refractory skull base tumors; preoperative assessment; surgical treatment; intraoperative precision identification technique; postoperative comprehensive therapy

復雜難治性顱底腫瘤作為一種發生在顱腦底部及其鄰近區域的腫瘤，通常具有復雜的解剖位置和臨床表現。由于其位置深、結構復雜，且常常與重要神經、血管結構緊密相鄰，因此其治療難度大、并發癥多。隨著醫學影像技術、人工智能、手術技術、術后創新療法的不斷進步，顱底腫瘤的診斷和治療在過去幾十年中取得了顯著的突破。……