Tutino M, Chico F, Tutino M, Goodrich J T, Monasterio F O
University of Palermo, Center for Craniofacial Disorders, Head and Neck Surgery and the Neurosciences, Italy.
Ann Plast Surg. 2000 Jan;44(1):1-7. doi: 10.1097/00000637-200044010-00001.
Endoscopic techniques are now an accepted part of the surgical armamentarium and are used routinely in a number of aesthetic and reconstructive procedures. Endoscopic techniques are now being used commonly by plastic surgeons in forehead and face lifts. In both craniofacial surgery and in neurosurgery, the application of endoscopy potentially allows the surgical team to perform wide dissection of the dura mater in a minimally invasive fashion, thereby potentially reducing the risk of dural and brain injury. Also reduced by this surgical approach is potential injury to the major venous structures, such as the sagittal sinus, along with overall reduced bleeding. After an extensive laboratory study of 10 cadaveric dissections, the authors have refined a new endoscopic technique for completing an endoscopic intracranial craniofacial osteotomy. This study was conducted in the Department of Pathology at the University of Brno (Czech Republic), and was performed as a cooperative multicenter project between the University of Palermo, the Albert Einstein College of Medicine/ Montefiore Medical Center, the Hospital Infantil de Mexico, "Federico Gomez," and the Medtronic Midas Rex Institute, (Fort Worth, TX). During this cadaveric anatomic study and using small trephinations and skin incisions the authors were able to develop several different craniofacial and endoscopic monobloc procedures. To accomplish intracranial and facial osteotomies, a new malleable high-speed drill was designed for use in the endoscopic craniofacial approach. Using these newly developed cadaveric techniques and instrumentation, the authors performed two intracranial craniofacial procedures on children with congenital craniofacial anomalies. There would appear to be several significant advantages for the craniofacial patient as result of these new techniques: reduced surgical trauma, operative bleeding, surgical time, and hospitalization, along with a reduced risk of infection. It became quickly apparent, as a result of these cadaveric studies, that the learning curve for this endoscopic procedure is quite steep. Tutino M, Chico F, Tutino M, Goodrich JT, Ortiz Monasterio F. Endoscopic intracranial craniofacial and monobloc osteotomies with the aid of a malleable high-speed pneumatic drill: a cadaveric and clinical study.
内镜技术如今已成为外科手术器械库中被认可的一部分，并常规应用于多种美容和重建手术中。整形外科医生目前在额头提升术和面部提升术中普遍使用内镜技术。在颅面外科手术和神经外科手术中，内镜的应用有可能使手术团队以微创方式对硬脑膜进行广泛剥离，从而有可能降低硬脑膜和脑损伤的风险。这种手术方法还能减少对主要静脉结构（如矢状窦）的潜在损伤，同时总体上减少出血。在对10具尸体进行广泛的实验室研究后，作者改进了一种新的内镜技术，用于完成内镜下颅内颅面截骨术。这项研究在布尔诺大学（捷克共和国）病理学系进行，是巴勒莫大学、阿尔伯特爱因斯坦医学院/蒙特菲奥里医疗中心、墨西哥儿童医院“费德里科·戈麦斯”分院和美敦力迈达斯雷克斯研究所（德克萨斯州沃思堡）之间的合作多中心项目。在这项尸体解剖研究中，通过使用小骨孔和皮肤切口，作者能够开发出几种不同的颅面和内镜整块手术。为了完成颅内和面部截骨术，设计了一种新的可弯曲高速钻头用于内镜颅面手术入路。利用这些新开发的尸体技术和器械，作者对患有先天性颅面畸形的儿童进行了两次颅内颅面手术。这些新技术似乎给颅面患者带来了几个显著优势：减少手术创伤、术中出血、手术时间和住院时间，同时降低感染风险。由于这些尸体研究，很快就明显看出，这种内镜手术的学习曲线相当陡峭。图蒂诺M、奇科F、图蒂诺M、古德里奇JT、奥尔蒂斯·莫纳斯特里奥F。借助可弯曲高速气动钻进行内镜下颅内颅面和整块截骨术：一项尸体和临床研究。
